Written by Elizabeth Cahya
Last Reviewed: August 2019
Review Due: August 2020
'are sac-like protrusions of mucosa through the muscular wall of the colon'
'is when the diverticula are asymptomatic'
'is when the diverticula are symptomatic'
'is an acute inflammation of diverticula'
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.
Meckel’s diverticulum. These involve all layers of the colonic wall
SIGNS AND SYMPTOMS1
Altered bowel habit
Intermittent abdominal pain (usually LIF) relieved by defecation
Diverticulitis - in addition to diverticulosis symptoms
Constant severe pain initially in the hypogastrium then proceeding to localise to the left iliac fossa
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.
Raised white cell count
Evidence of obstruction or perforation
Evidence of perforation - pneumoperitoneum
CT Abdomen with contrast
Evidence of acute inflammation or abscess
Increase fibre in diet
Increase fluid intake
Use of laxative
NBM (bowel rest)
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
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
Diverticular Disease. NICE Clinical Knowledge Summary 2019
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.
Diverticular disease. BMJ Best Practice 2018