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.
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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
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Diverticular disease
Conservative
Increase fibre in diet
Increase fluid intake
Use of laxative
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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
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Diverticular Disease. NICE Clinical Knowledge Summary 2019
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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.
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Diverticular disease. BMJ Best Practice 2018