Colorectal diverticulitis disguised as appendicitis

A 62-year-old healthy male working in Chiayi recently went to the hospital because of fever, severe pain in his right lower abdomen for two days, nausea and vomiting, and bloody stool. The main symptoms of the above patients are very similar to typical acute appendicitis (often mistaken for appendicitis), but after abdominal computed tomography, it is found that the appendix of the patient is intact, and the result is diverticulitis.

What is colorectal diverticulosis?

Diverticular disease exists more or less in the intestines of normal people. Diverticular disease is caused by the increase of internal pressure in the large intestine, which weakens the muscular layer of the intestinal wall, so that the intestinal mucosa is squeezed out of the muscular layer of the intestinal wall (especially the point where blood vessels enter the intestinal wall), resulting in bag-like protrusions. It often occurs in middle-aged and elderly people, and the incidence increases with age. People who eat less fiber and have constipation for a long time also have a higher probability of constipation.

Ascending colon, descending colon and sigmoid colon are the most common sites of colorectal diverticulosis.

Most people with colorectal diverticulosis do not feel uncomfortable or show only mild symptoms. Occasionally, slight abdominal pain, abdominal distension, constipation or irregular defecation habits will not cause inconvenience in daily life.

What is diverticulitis?

When inflammation or infection occurs in diverticulum, it is called diverticulitis, which will be accompanied by severe abdominal pain, abdominal tenderness, fever, sepsis, leukocytosis and infection. The main symptoms of diverticulitis are severe abdominal pain and fever, and the location of abdominal pain mainly varies according to the location of intestinal inflammation. Diverticulitis of sigmoid colon and descending colon usually causes severe left lower abdominal pain and lower abdominal pain. Diverticulitis of ascending colon often causes pain in the right lower abdomen, but it is similar to acute appendicitis, so it is often mistaken for acute appendicitis.

Classification and treatment of diverticulitis of large intestine

Diverticulitis can be divided into simple and complex.

Simple diverticulitis has mild symptoms. Computed tomography showed that the wall of the large intestine was thickened and inflamed, and the tissues around the inflamed large intestine had no symptoms of abscess and perforation. Most patients can be cured only by intestinal rest, intravenous nutrition supplement and taking antibiotics, without surgical intervention.

Complicated diverticulitis, in addition to inflammation and thickening of the large intestine wall, CT scan shows that abscess accumulates in the tissues around the large intestine due to serious inflammation and infection, or is combined with intestinal ischemic necrosis, which leads to perforation of the large intestine and the formation of air in the abdominal cavity.

At this time, patients are usually accompanied by severe abdominal pain, fever and sepsis. At this time, in addition to antibiotic treatment, combined with CT-guided abscess drainage or laparoscopic abscess drainage, in order to speed up the elimination of abdominal abscess.

If the symptoms do not improve, surgery is needed to remove the diseased intestinal segment of colorectal diverticulitis.

Timing of surgical intervention

When patients with diverticulitis have been hospitalized for more than 2~3 times in a short period of time or the inflammatory symptoms have not improved significantly after antibiotic treatment, surgery is needed. Generally speaking, patients with complex diverticulitis have a higher probability of recurrent diverticulitis and failure of antibiotic treatment, and need surgical treatment more.

In order to control and improve the symptoms of sepsis, infection or peritonitis, the diseased intestine must be removed during operation.

Dietary suggestions for patients with diverticulitis after rehabilitation.

After the treatment of diverticulitis, the intestinal wall of the large intestine has been repaired and the inflammatory symptoms have been alleviated. Work and rest, like normal people, do not need to restrict diet, but some suggested diets are as follows:

Moderate intake of high fiber food:

Eating high-fiber food can soften and increase the volume of feces, and the softened feces can easily reach the mouth through the colon, which can reduce the formation of constipation and reduce the pressure in the digestive tract. Many studies have shown that eating foods rich in fiber is helpful to control the symptoms of diverticulum. Try to eat at least 25~35 grams of fiber every day.

Here are some foods rich in fiber:

A. Cereals: white rice, brown rice, corn, oats, wheat, buckwheat, coix seed and cereal bread.

B. beans: peas, black beans, mung beans, red beans and soybeans.

C. Rhizomes: sweet potato, taro, potato, pineapple and bamboo shoots.

D. vegetables: spinach, cabbage, lettuce, cauliflower and celery.

E. Fresh fruits: apples, bananas, pears, Liu Ding and guava.

Replenish at least 2000 ml of water every day;

If the fiber intake is not matched with enough water intake, the feces will be excessively dry, which is counterproductive. It is necessary to replenish enough 2000CC of water every day. Cellulose, like a sponge, can absorb and keep the moisture in feces, soften feces, and keep feces soft and easy to discharge, so taking more water can improve the effect of fiber softening feces.

Foods to avoid:

Indigestible fruit seeds: Try not to eat watermelon seeds, grape seeds and guava seeds, so as not to increase the chance of inflammation because the seeds get stuck in the lounge. However, recent research points out that there is no real scientific evidence to support this proposal. However, these seeds will not be digested when they enter the body, so try to avoid swallowing when ingesting.