Diverticulosis

• • Diverticula are more common in the colon than in any other portion of the GI tract

  • Diverticulosis: the presence of multiple false diverticula

  • Colonic diverticula are acquired and are classified as false because they consist of mucosa and submucosa that have herniated through the muscular coats

  • Colonic diverticula are pulsion (rather than traction) diverticula because they are pushed out by intraluminal pressure

  • They vary from a few millimeters to several centimeters in diameter; the necks may be narrow or wide; and some contain inspissated fecal matter

  • Cultural factors, especially diet, play an important etiologic role

  • -Chief among the dietary influences is the fiber content of foods.

  • The pathogenesis of diverticula requires defects in the colonic wall and increased pressure in the lumen relative to the serosal surface

Epidemiology

• • 95% of patients with diverticula have involvement of the sigmoid colon

  • Descending > transverse > ascending

  • Solitary cecal and multiple right colonic diverticula seen in Asian people

  • In Western countries, diverticula develops in perhaps 50% of persons; 10% by age 40 and 65% by age 80

  • Diverticular disease is more common in Western nations than in Japan or in developing countries of the tropics

Symptoms and Signs

• • Diverticulosis probably remains asymptomatic in about 80% of people and is detected incidentally on barium enema x-rays or endoscopy if it is discovered at all

  • May present with lower GI bleeding

  • Episodic pain, constipation, diarrhea

  • Left lower quadrant tenderness

  • Left colon is sometimes palpable as a firm tubular structure

Laboratory Findings

• • Normal WBC count in uncomplicated cases

  • Leukocytosis, anemia in complicated cases

Imaging Findings

• •Barium enema

  • -Diverticula

    -Segmental spasm

    -Muscular thickening that may narrow lumen

    -Saw-toothed appearance

• • Diverticulitis

  • Neoplasm (colonic, anal)

  • AV malformation

  • Hemorrhoids

Rule Out

• • Neoplasm

• • History and physical exam

  • Digital rectal exam

  • Lower endoscopy

  • -Colonoscopy

    -Flexible sigmoidoscopy

When to Admit

• • Abdominal pain

  • GI bleeding

  • Inability to distinguish diverticular disease from neoplasm

• • Asymptomatic persons with diverticulosis may be given a high-fiber diet

  • Symptomatic patients also can be treated with a high-fiber diet

  • Analgesics should be avoided, but if pain relief is necessary, nonopioid medications are preferred

  • Education, reassurance, and a strong relationship between physician and patient are important to successful management

Surgery

Indications

• • Massive hemorrhage or to rule out carcinoma in some patients

Contraindications

• • Colon resection for uncomplicated diverticular disease or irritable bowel syndrome is rarely necessary or advisable

Medications

• • Dietary fiber

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