Diverticular Disease

“An umbrella term describing outpouching of the colonic mucosa and underlying connective tissue through the colon wall”

• Diverticula – multiple outpouchings of the colon wall Diverticulosis – the presence of diverticula without symptoms
• Diverticulitis – inflammation of the diverticula

Risk Factors

• Modifiable:
  • Obesity
  • Low-Fibre diet
  • Medications
    • NSAIDs
    • Corticosteroids
  • Smoking
  • Exercise
• Non-Modifiable:
  • Age
  • Sex (Male)

Aetiology

No known cause.

Pathophysiology

1. Increased pressure in the lumen of the colon
2. An outpouching forms at a weakness in the wall

Clinical Presentation

• Presents in 4 ways:
  1. Asymptomatic – majority of cases
  2. Painful diverticular disease – pain in left lower iliac fossa
  3. Bleeding diverticular disease – haematuria
  4. Diverticulitis
     • Nausea
     • Fever
     • Tachycardia
     • Diarrhoea
     • Acute left iliac pain

Investigations

• Bloods:
  • FBC and CRP – looking for infection
• Imaging: n/a
• Special:
  • Barium enema – may reveal diverticula, strictures and associated complications)
  • Colonoscopy – may reveal co-existing complications

Management

• Dietary changes – Increased fibre, increased water intake
• Treatment of exacerbation – diverticulitis (IV antibiotics, analgesia, IV fluids)
• Surgery – segmental colectomy

Complications

• Haemorrhage
• Perforation
• Abscess
• Fistula (between the colon and bladder/vagina)
• Ileus/obstruction