- Colonic diverticulae are outpouchings of colonic wall
- Usually result from herniation of mucosa through muscular wall
- Occur at sites where mesenteric vessels penetrate the bowel wall
- Most common in sigmoid colon
- Increased prevalence with age
- 10% population at 40 years
- 60% population at 80 years
- More common in developed countries
Aetiology
- Due to lack of dietary fibre in Western diets
- Low dietary fibre results in low stool bulk
- Induces increased segmentation of colonic musculature resulting in
hypertrophy
- Increased intraluminal pressure results in herniation
Complications
- Diverticulitis
- Pericolic abscess
- Purulent peritonitis - due to rupture of pericolic abscess
- Faecal peritonitis - due to free perforation of diverticulum
- Fistula - to vagina, bladder, skin
- Colonic stricture
Picture provided by Josi Garcia, Tampico, Mexico
Picture provided by Colm O'Boyle, Hull Royal
Infirmary, United Kingdom
Investigation
- Plain X-rays with positive diagnostic features (e.g. free gas, gas
in bladder) are useful
- Normal X-rays can not exclude complications of diverticular disease
- Double contrast barium enema - allows diagnosis, assessment of
extent and complications
- CT +/- intravenous and rectal contrast - useful for imaging
abscesses, fistulae
Treatment
- Bowel rest by restricting oral intake and intravenous fluids
- Intravenous antibiotics - 2nd generation cephalosporin
(e.g. cefuroxime) and metronidazole
- Active observation for the development of complications
- If abscess formation - percutaneous drainage under radiological
guidance usually possible
- Subsequent elective resection and primary anastomosis often required
Bibliography
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Jones S E J, Meagher A, Fizelle F A. Management of
diverticulitis. BMJ 2006; 332: 271-275.
McKee R F et al.
Radiological investigation in acute diverticulitis.
Br J Surg 1993; 80: 560 - 565.
Paterson-Brown S. The use
of laparoscopy in the acute abdomen. Curr Pract in Surg
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Simpson J, Scholefield J H, Spiller R C.
Pathogenesis of colonic diverticula. Br J Surg 2002;
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Stollman N, Raskin J B. Diverticular disease of the colon.
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