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What Is Diverticulitis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Diverticulitis is a form of colitis, an inflammatory bowel disease; it can be serious and require surgery if it isn’t caught quickly and treated.

The condition happens when small pouchlike structures called diverticula form in the digestive tract (when in this location, they're called diverticulosis) and become infected or inflamed, according to the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK). (2)

Signs and Symptoms of Diverticulitis

While diverticulosis doesn’t present symptoms, there are clear warning signs of diverticulitis, per the NIDDK: (3)

    or tenderness
  • Change in bowel habits
  • Fever
  • Chills
  • Nausea and vomiting
  • Loss of appetite
  • Diarrhea

Although some of these symptoms overlap with other gastrointestinal problems, including peptic ulcers and irritable bowel syndrome, consult your doctor if you have any of these symptoms and the risk factors apply to you, notes the NIDDK. (3)

What Does Diverticulitis Pain Feel Like?

The most common symptom of diverticulitis is a sharp pain in the lower left abdomen. This corresponds to the location of the sigmoid colon. The condition can also cause pain in the lower right abdomen.

Diverticulitis pain can come on suddenly and severely, or it may increase in severity over a period of days. It can also fluctuate in intensity.

Ultimately, the degree of pain you experience from a flare-up of diverticulitis depends on the severity of your infection and whether it has spread to other areas of your body, notes the American Society of Colon and Rectal Surgeons (ASCRS). (4)

Advanced Symptoms of Diverticulitis

If you experience any of these advanced symptoms, this may be an indication that a diverticulitis complication has developed: (4)

  • Fever over 100 degrees F (38 degrees C)
  • Worsening or severe abdominal pain
  • Inability to tolerate fluids

If you have any of these symptoms, get in touch with your doctor as soon as possible.

Common Questions & Answers

Causes and Risk Factors of Diverticulitis

Diverticula form when the inner soft-tissue layer of the intestine passes through the outer muscular layer, forming a pocket or pouchlike and marble-sized bulge. This happens most often where the muscles of the intestine are weakest, particularly in the sigmoid colon. (2)

It’s unclear why diverticula form, but the Mayo Clinic notes that they’re linked with these facors: (5)

Being Obese Having a body mass index of 30 or over means you’re obese.

Eating Too Much Red Meat There’s no rule about how much red meat is too much, but generally, dietitians recommend opting for leaner sources of meat (like fish, turkey, and boneless, skinless chicken) when possible, according to Harvard Health Publishing. (6)

Not Exercising Regularly Aim for 150 minutes of moderate-intensity aerobic exercise (such as brisk walking) each week, per the Centers for Disease Control and Prevention. (7)

Why Diverticula Progress to Diverticulitis

Doctors and researchers aren’t certain what causes diverticula to become inflamed or infected, but they have identified several possible causes.

Is It Gas Pain or Something More Serious?

The most widely accepted theory is that increased pressure in the colon, caused by constipation or other digestive problems, can lead to tears in the wall of a diverticulum. Bacteria or hard fecal material present in the intestine can then become lodged in the diverticulum, causing inflammation and infection. (5)

Can Eating Nuts and Seeds Increase Your Risk for Diverticulitis?

This theory explains why, for decades, doctors advised people with diverticulosis (the presence of diverticula) not to eat nuts, seeds, or popcorn, which they believed could block the openings of the diverticula and lead to flare-ups of diverticulitis.

But the Mayo Clinic points out that research has never proved that eating these foods increases the risk of developing diverticulitis, so doctors no longer warn their patients away from such foods. (8)

Nondietary Risk Factors Linked With Diverticulitis

These factors may increase the likelihood of developing diverticulitis: (3)

  • Aging
  • Decreased levels of serotonin in the brain
  • Genetics
  • Obesity
  • Lack of exercise

Several drugs are associated with an increased risk of diverticulitis: (5)

  • Steroids
  • Opiates

Can a Low-Fiber Diet Cause Diverticula to Form?

Research suggests that the link between eating a low-fiber diet and an increased risk for diverticulitis is simply that — a link without a causal relationship, at least for now.

Scientists long believed that not eating enough fiber could increase the risk of diverticulosis, but research suggests that’s not necessarily the case. (9)

That said, a high-fiber diet is one of the main treatments for diverticulitis (more on this later).

Article

Why Is Fiber Important in Digestive Health?

How Is Diverticulitis Diagnosed?

If you are experiencing any of the symptoms of diverticulitis, the Mayo Clinic notes that your doctor will likely take the following actions: (10)

  • Gather information about your full medical history, including preexisting conditions and risk factors.
  • Examine your abdomen to check for tenderness.
  • Perform a rectal exam to check for rectal bleeding.
  • Perform a blood test to check your white blood cells and determine if you have an infection.
  • Order a diagnostic test to get a picture of your colon and determine if diverticula are present and whether they are inflamed or infected.
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These are the most common tests used to diagnose diverticulitis: (10)

CT Scan A CT scan uses both X-rays and computer technology to create three-dimensional images of your colon. It's the test most commonly used to confirm a diagnosis of diverticulitis.

Abdominal X-Ray During this test, your doctor will use imaging of your abdomen to diagnose diverticulitis.

Barium Enema A barium enema is another type of X-ray exam in which a liquid containing the element barium is injected into the colon, where it coats the lining of the intestines and allows for a clear image to be captured.

Colonoscopy During a colonoscopy, a long flexible tube is inserted into the rectum with a video camera at its tip. The camera allows doctors to view the inside of the colon and determine if diverticula are present in the colon, and whether they are inflamed or infected.

Ultrasound and Magnetic Resonance Imaging (MRI) Ultrasounds and MRIs can also be used in the diagnosis of diverticulitis, although they are less common due to cost.

Prognosis of Diverticulitis

While some people with diverticulitis will require surgery, many can be treated at home. However, if you experience increasing pain, fever, or an inability to tolerate fluids, you may need to be hospitalized, as these symptoms may indicate that complications from diverticulitis have developed. (4)

Your doctor may recommend hospitalization if you have the following characteristics or symptoms: (11)

Fantasy Sports, Trading Platform Beryllium Raises $3 Million In Pre-Series A Funding

Amay Makhija is the founder of Beryllium, a fantasy sports and trading platform that recently . [+] secured $3 million of pre-Series A funding.

In February, Amay Makhija sent an email to Paul Martino, general partner and co-founder of Bullpen Capital, a San Francisco venture capital firm that has invested in more than 100 companies since 2010. Makhija, an entrepreneur who lives in Singapore, knew that Bullpen was an early investor in FanDuel, a fantasy sports pioneer, but he had never met Martino.

Still, Makhija wanted to connect with Martino to discuss Beryllium, a fantasy sports and trading platform focused on cricket in India that Makhija had founded two years ago. To Makhija’s surprise, Martino responded to the request and took time to speak with Makhija for about an hour. That was the first of many conversations between the men and the start of what they hope will be a successful partnership.

Today, Beryllium is announcing that it has secured $3 million of funding in a pre-Series A round led by Bullpen. Other investors in the round include Genting Ventures of Singapore and Velo Partners of the United Kingdom. Beryllium raised $600,000 in a seed round in November 2019 and was judicious when it came to seeking additional funding.

“We have been very careful about the investors we’ve brought in,” Makhija said. “In today’s venture capital market, there’s a lot of cash that’s floating around, but the most important factor for us was having strong investors that we believe are going to be great partners and mentors for us and help me navigate the sector.”

Makhija had first thought about launching Beryllium in 2017 when he was working for L2 Inc., a digital consulting company. Makhija, who earned his undergraduate degree from New York University’s business school in 2016, saw that fantasy sports and retail trading of stocks were becoming more popular in the U.S. He thought they would get bigger in Asia, as well.

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Two companies in India, in particular, caught his attention: Zerodha, a trading platform, and Dream11, a fantasy sports platform. Two years ago, Makhija left L2 and founded Beryllium with the goal of creating an app where people could play fantasy sports and also participate in a trading environment based on players’ performances. Each player is assigned a value, which can increase or decrease depending on how they perform.

“I felt there was an opportunity to look at the market differently,” Makhija said. “I felt in trading you had this extremely engaged, long-term user base that was almost never going to drop off once they started trading. On the other hand, you had fantasy sports, which has enormous scale but it’s always been a difficult proposition to keep users engaged for a long time.”

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He added: “My idea was how do we take the mechanics we see in trading with this long-term behavior and bring it to something that has a lot of scale, a lot of excitement, a lot of emotive connection, which is fantasy sports.”

Last year, Beryllium launched its first game, called Sixer, which focuses on cricket and is available only in India. So far, Sixer has more than 150,000 users, according to Makhija. Sixer offers both free games and contests for money.

Beryllium plans on adding other sports, starting with tennis later this year. It will continue to only be available in India for now but could expand to additional countries in the coming years.

“We have a long-term vision of being a multi-sport, multi-regional product,” Makhija said.

Beryllium plans on using proceeds from its latest funding round to continue to improve the app and user experience and add to its staff. The company now has 13 full-time employees but expects to hire 10 more people in the coming months.

Martino, the co-founder of Bullpen Capital, said he was attracted to Beryllium in large part because of the data the company shared and Bullpen verified on how long Sixer’s users remain on the app and how often they come back. He envisions the same thing happening with other sports, as well.

“We see the mechanics that Amay has figured out could be broadly applicable to both team sports and individual sports across the world,” Martino said. “The engagement numbers they have by crossing (daily fantasy sports) with trading was unlike anything we had seen.”

Can fruit seeds and undigested plant residuals cause acute appendicitis

To investigate the relation between fruit seeds, plants residuals and appendicitis.

Methods

Among cases that underwent appendectomy, the appendicitis cases having fruit seeds and undigested plant residuals in their etiology were examined retrospectively. Also, histopathological features, age, sex, and parameters of morbidity and mortality were used.

Results

Fruit seed was found in one case (0.05%) with presence of pus in appendix lumen, undigested plant residuals in 7 cases (0.35%). It was determined that there were appendix inflammation in 2 of the plant residuals cases, while there were obstruction and lymphoid hyperplasia in the appendix lumen of 5 cases. No mortality was observed.

Conclusions

The ratio of acute appendicitis caused by plants is minimal among all appendectomised patients, but avoidence of eating undigested fruit seeds and chewing plants well may help to prevent appendicitis.

1. Introduction

The acute appendicitis observed in almost 7% of population is an acute illness of the Appendix vermiformis. It is the most common disease which requires emergent surgery. The obstruction of appendix lumen is the main cause of appendicitis. Basically fecalith, lymphoid hyperplasia, seeds of fruits and vegetables, barium obturator, and tumors of large intestine and appendix can be found as etiology of acute appendicitis. In our study, the cases with presence of undigested plant residuals and fruit seeds in the appendix lumen were studied and were discussed together with the literature data[1]–[5].

2. Materials and methods

Our study is a retrospective clinical study. The specimen removed from the patients operated under general anesthesia with the diagnosis of acute appendicitis was put into sterilized bottles with 10% formal-saline solution and was sent to pathology laboratory. Cases with presence of undigested plant residuals and fruit seeds in their etiology were involved in our study according to the result of pathological examination. The relation between age, sex, histopathological features and mortality of the studied cases were discussed.

3. Results

Among 1 969 cases diagnosed as acute appendicitis that underwent appendectomy between 2002 and 2009, 8 cases with presence of undigested plant residuals and fruit seeds were studied (0.4%, 8/1 969) with female/male ratio of 7/1. Their average age was 39 and all showed similar main complaints and examination findings as other acute appendicitis.

All 8 cases were discharged from hospital without any complication. Confirmed by histopathological examination, undigested plant residuals and fruit seeds were found in 7 and 1 cases, respectively ( Figure 1 and ​ and2). 2 ). There was pus in appendix lumen of the fruit seed case. Appendix inflammation was presented in 2 cases having undigested plant residuals in lumen, but not in other 5 cases. However, lumen obstruction and lymphoid hyperplasia were determined in these 5 cases. 7 out of the 8 patients underwent appendectomy during autumn and winter months, and (fruit seed case) in June.

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4. Discussion

Generally speaking, the relation between appendix base and cecum do not change, but tip of appendix can be in different directions. The positions relative to the direction of appendix can be as follows: retrocecal, pelvic, sub-cecal, ileocecal and right pericolic[6].

Appendicitis is more common in males with a ratio of male/female of 1.4/1. It was estimated that 8.6% of men and 6.7% of women develop acute appendicitis in their lifelong. Young age is a risk factor, and nearly 70% of appendicitis cases are under 30. Appendix can be infiltrated by materials such as fecal material, microbes and parasites. Because most of these materials are on the streamlines, they can enter into organ lumen without leading to any symptoms. However, this can cause inflammation such as appendicitis. When appendicular mucosa continues fluid secretion, the internal pressure of lumen in obstructed appendix increases, and the increased pressure on appendix wall can lead to mucosal ischemia by exceeding the capillary pressure. Bacterial reproduction and translocation in internal lumen sticks to all wall layers of appendix, and leads to inflammation, edema and necrosis. The typical clinical process begins with intermittent stomachache like cramps thought to be caused by the blockage of appendicular lumen. Pain can be partially or extensively around navel, and can be difficult to localize. Typically, this is followed by nausea, but nausea can also not be presented. When inflammation becomes transmural and causes pyogenesis in peritoneum covering right lower quadrant, the character of pain would be changed and the obtuse colic pain would be replaced by constant and severe pain[1],[3],[7]–[10].

95% of the substances which are taken orally but not digested pass through the digestive system without any problem. More heavier substances, on the other hand, locate in the lower part of cecum and can easily enter appendix lumen. Because the peristaltic activity of appendix is not able to discharge this substance into cecum, the accumulation of foreign bodies can lead to obstruction of the lumen, and therefore lead to inflammation. The foreign bodies leading to appendicitis can be listed as follows; metal needles, shot particles swallowed by eating the animals meat, tooth stick, tooth fills, as well as fruit seeds. Some of the fruit seeds swallowed are removed from the body naturally, while some of them can be the cause of appendicitis. There are reported cases of appendicitis which are caused by seeds of vegetables and fruits such as cocao, orange, melon, barley, oat, fig, grape, date, cumin, and nut[11]–[14].

Materials in the appendix lumen (e.g. fecalith) do not cause inflammation of the appendix all the time but these may cause acute abdominal pain that mimics acute appendicitis and this patients are required to undergo appendectomy for acute appendicitis. So in appendectomy series the range of fecalith in noninflamed appendix is 20%-30%[15],[16].

In the series which Byard and his colleagues published in 1988, it was reported that among 1 409 appendectomy materials, fruit seed was observed only in one of the cases.(1/1 409, 0.07%)[17].

In one study, fruit seed was found in 1 among 1 969 appendectomy materials (1/1 969, 0.05%). 34 fruit seed cases were reported by others[18].

Since the fruit seeds in appendix are very rare, relevant publications are generally submitted to literature as case reports. The appendicitis cases with fruit seeds included in this study were similar to that reported by Byard et al. We consider that those 34 fruit seed subjects in literature do not reflect the facts due to the publishing criteria of the journals as well as the difficulties in scanning articles of the journals, and lack of indexing. Moreover, though appendectomy is the most common general surgical operation and can be performed in all hospitals, yet no publications related to the series are available in hospitals.

Phytobezoar develops through the combination of plant substances which are not digested in the gastrointestinal system[19]–[21].

Since undigested plant wastes are observed in the lumen of appendectomy material, they can be called as ‘microphytobezoar’. It was reported that phytobezoars consisting Trabzon palm or citrus led to intestinal obstruction[22]–[25].

Most of the people eat fruit seeds and plant residuals do not develop appendicitis generally. Ratio of acute appendicitis caused by plants is minimal in all appendectomised patients. Nevertheless, we would like to suggest undigested fruit seeds shouldn’t be eaten and plants be chewed well. We think that clinically and laboratory training must be performed in this area[26].

Acknowledgments

We would like to express our special thanks to Professor Ziya Alkan (Ege University Medicine Faculty, Parasitology Department) for his kind help in this study.