Diverticular disease 

Written by  Elizabeth Cahya

Last Reviewed: August 2019

Review Due: August 2020

 

DEFINITION1,2

Diverticula

'are sac-like protrusions of mucosa through the muscular wall of the colon'

 

Diverticulosis

'is when the diverticula are asymptomatic'

 

Diverticular disease

'is when the diverticula are symptomatic'

 

Diverticulitis

'is an acute inflammation of diverticula'

 

AETIOLOGY3

Acquired

Most common cause of diverticulum. These are usually false diverticula which involve only the  mucosa and muscularis mucosa.

Risk factors include low dietary fibre and being older than 50.

Obesity and NSAID use increase risk of diverticular bleed. 
 

Congenital 

Meckel’s diverticulum. These involve all layers of the colonic wall

SIGNS AND SYMPTOMS1

Diverticulosis

Altered bowel habit

Intermittent abdominal pain (usually LIF)  relieved by defecation

Rectal bleed 

Nausea

Flatulence

 

Diverticulitis - in addition to diverticulosis symptoms 

Pyrexia

Constant severe pain initially in the hypogastrium then proceeding to localise to the left iliac fossa 

 

PATHOPHYSIOLOGY3

Most commonly the sigmoid colon is affected. A low-fibre diet increases intestinal transit time and decreases the stool volume.

 

This results in high intraluminal pressure forcing the mucosa to herniate through muscle layers.

 

Weak points exist between taenia coli where vessels pierce the muscle to supply the mucosa.


 

 

Perforation

Hemorrhage

Fistulae

Abscesses

Post-infective Stricture

Complications3

 
 

Investigations2,3

Diverticular disease 

Colonoscopy 

CT Abdomen
 

Acute diverticulitis 

FBC

Raised white cell count 

CRP/ ESR

Raised

Abdominal Xray

Evidence of obstruction or perforation 

Erect CXR

Evidence of perforation - pneumoperitoneum

CT Abdomen with contrast

Evidence of acute inflammation or abscess

 

TREATMENT2

Diverticular disease 

Conservative

Increase  fibre in diet
Increase fluid intake
Use of laxative

 

Diverticulitis

Analgesia 

NBM (bowel rest)

IV Fluids 

Antibiotics  

Drainage of pericolic abscess (CT-guided or surgically)

Emergency colonic resection (if perforated, peritonitis)
Hartmann’s (partial colectomy + temporary colostomy)

Elective resection (if recurrent bleed, stenosis, fistulae)
 

* Colonoscopy should not be performed during a suspected acute attack due to the risk of perforation

 

Diverticular disease

Diverticulitis

EPIDEMIOLOGY3

Incidence in the UK is estimated to be 5 to 12 cases per 100,000 people, and the prevalence is 50 per 100,000 people.

 

 
 

In the UK the proportion of the population with diverticular disease is:

10% of people < 40 years old

50% of people > 50 years old

up to 70% of people > 80 years old

REFERENCES

  1. Diverticular Disease. NICE Clinical Knowledge Summary 2019

  2. Tursi, A., Picchio, M. and Elisei, W. et al (2016) Management of patients with diverticulosis and diverticular disease. Consensus statements from the 2nd international symposium on diverticular disease. J Clin Gastroenterol. 50(1), 101-107.

  3. Diverticular disease. BMJ Best Practice 2018

 
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