Staging
According to its severity, colon diverticulitis can be divided into different stages. According to the stage classification, there are therapeutic consequences for the patients. In everyday clinical practice, the classification according to Hansen and Stock has proven to be successful.
Therefore, the results of the physical examination, the colon contrast enema or computer tomography and colonoscopy are considered together. Stage 0 is not treated, stage I is usually treated conservatively. Stage IIa and b should be operated on as soon as possible.
Stage IIc is an emergency and must therefore be operated on immediately. Stage III can be operated on at the earliest after the second relapse in a state as free of inflammation as possible.
- “Stage 0” represents the complication-free diverticulosis.
The diverticula can be detected by imaging, but the patient has no complaints.
- In “stage I” one already speaks of an acute diverticulitis, although this is uncomplicated in comparison to “stage II”. The patient complains of pain in the lower abdomen and may develop elevated temperatures.
- Stage II” is subdivided into a-c, increasing according to the severity of the complication. In stage IIa, a hardening in the lower abdomen is palpable, the patient feels a pressure pain, develops a local defensive tension and may have a fever. Intestinal paralysis, irritation of the peritoneum and fever can be detected in stage IIb (abscess formation, covered perforation). In stage IIc, there is a free intestinal rupture, which leads to an acute abdomen.
- In “stage III” the patient has already had several relapses and further relapses are to be expected under continuous complaints.
Summary
Diverticulitis is an inflammatory change of one or more sacs in the intestinal area (diverticula). In most cases, diverticulitis is characterized by stabbing and pulling pain in the left upper abdomen. The main treatment is the administration of antibiotics or a wait-and-see approach.
In the case of a so-called uncomplicated diverticulitis, where the affected person has no other risk factors, it is possible to wait and observe the further course of the disease. If the symptoms are severe and the course is complicated, antibiotic treatment should be started as soon as possible. Although studies have not shown that the administration of several combined antibiotics has an advantage over individually given antibiotics, the principle of combination has become common practice in practice and in hospitals and is applied.
The following antibiotic medications are given to patients with diverticulitis as an infusion or as a combined tablet Ciprofloxacin+ metronidazole or piperacillin+tazobactam or ceftriaxone. It is also possible to start with an infusion treatment first and then switch to a treatment with tablets. In addition, a light diet should be maintained for the duration of the symptoms and care should be taken to ensure a sufficient amount to drink.
