Chapter 47: Colon and Rectum- Diverticulosis

Question 1

What is diverticulosis?

Answer 1

• Condition in which diverticula can be found within the colon
  
  • especially the sigmoid
• diverticula are actually false diverticula in that only mucosa and submucosa herniate through the bowel musculature
  
  • true diverticula involve alll ayers of the bowel wall and are rare in the colon

Question 2

Describe the pathophysiology

Answer 2

• Weakness in the bowel wall develops at points where nutrient blood vessels enter between antimesenteric and mesenteric teniae;
• increase intraluminal pressures then cause herniation through these areas

Question 3

What is the incidence?

Answer 3

≈50% to 60% in the United States by age 60, with only 10% to 20% becoming symptomatic

Question 4

What is the most common site?

Answer 4

95% of people with diverticulosis have sigmoid colon involvement

Question 5

Who is at risk?

Answer 5

• People with low-fiber diets
• chronic constipation
• and a positive family history
• incidence increases with age

Question 6

What are the symptoms/complications?

Answer 6

• Bleeding: may be massive
• Diverticulitis
• asymptomatic (80% of cases)

Question 7

What is the diagnostic approach:

Bleeding?

Answer 7

Without signs of inflammation: colonoscopy

Question 8

What is the diagnostic approach:

Pain and signs of inflammation?

Answer 8

Abdominal/pelvic CT scan

Question 9

What is the treatment of diverticulosis?

Answer 9

High-fiber diet is recommended

Question 10

What are the indications for operation with diverticulosis?

Answer 10

• Complications of diverticulitis
  
  • fistula
  • obstruction
  • stricture)
• recurrent episodes
• hemorrhage
• suspected carcinoma
• prolonged symptoms
• abscess not drainable by percutaneous approach

Question 11

When is it safe to get a colonoscopy or bariumenema/sigmoidoscopy?

Answer 11

Due to risk of perforation, this is performed 6 weeks after inflammation resolves to rule out colon cancer