Disorders of the Gastrointestinal System, 2nd Edition
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weakens the intestinal wall around the sac, inhibits blood supply to the walls of the sac, and traps bacteria. This makes the sac susceptible to bacterial infection and inflammation and may lead to perfo - ration, obstruction, peritonitis, or hemor- rhage (Ghoulam, 2019). Sometimes the inflamed portion of the colon may adhere to organs such as the bladder, causing scar tissue that can subsequently cause other abdominal complications (NIDDK, 2021). A low-fiber, high-sugar, high-red-meat content diet is believed to contribute to the development of diverticular disease because inadequate fiber can increase fe - cal residue, narrow the lumen of the bow- el, and exert high intra-abdominal pres- sure during the elimination of feces. Still, more research is needed in this area. Di- verticulosis is most prevalent in industri- alized countries where low-fiber diets are common. Areas where people consume diets high in fiber, such as Asian and Afri - can countries, have a low incidence of the disease (Ghoulam, 2019). Obesity, smok- ing, a sedentary lifestyle, and a decrease in the normal bacterial flora of the GI tract are also associated with the development of diverticular disease and diverticulosis (Pemberton, 2021). | NURSING CONSIDERATION All new, prolonged, or worsening rec- tal bleeding must be medically eval- uated as soon as possible. The cause may be self-limiting and minor or quite serious. Encourage all patients to seek prompt evaluation for rectal bleeding and moderate or severe abdominal pain (Penner, 2022).
Several potentially lethal complications of diverticular disease stem from divertic- ulitis. These are discussed in the following sections. Hemorrhage Hemorrhage because of diverticulitis is relatively uncommon, although its inci- dence is increasing and can range from minimal to severe (Mizuki et al., 2018). Di - verticular bleeding stops spontaneously without medical intervention in approx- imately 75% of people who experience it. However, when hemorrhage does oc- cur, it can cause massive blood loss. It is believed that such bleeding results from blood vessels in a diverticulum that weak- en and burst. Patients may experience severe hemorrhage and require swift medical intervention, blood transfusion, colonoscopy, or even surgery to identify the site and cause of bleeding (Pember- ton, 2021). Fistula A fistula (an abnormal opening or con - nection of tissues between two organs or between an organ and the skin) can be a complication of diverticulitis. In the case of infection related to diverticulitis, the in- fection may migrate outside of the colon, causing the colon’s tissue to adhere to nearby tissues. This most often involves the bladder, small intestine, and skin tis- sue. Fistulas between the colon and the bladder are the most common and can lead to severe urinary tract infections. Symptoms may be confused with bladder infections. Peritonitis can also be caused by intestinal matter draining into the ab- dominal cavity. Surgery is often necessary to remove the fistula and affected parts of the colon (Pemberton, 2022a).
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