Diverticular Disease

Question 1

How does chronic diverticular disease present?

What is important about this presentation?

Answer 1

• Change in bowel habit with alternating constipation and diarrhoea
• Large bowel obstruction: vomiting, distention, pain, constipation
• Blood and mucous per rectum

This presentation is an exact mimic of local features of colon cancer, therefore malignancy must always be ruled out.

Question 2

What investigations are indicated in diverticular disease?

Answer 2

• CT
• Colonoscopy and sigmoidoscopy to visualise, although oedema may block passage of instrument
• Barium enema, demonstrates diverticula as globular outpouchings.

Question 3

What is the treatement of acute diverticulitis?

Answer 3

Fluids and antibiotics

Majority of cases settle with this approach.

Question 4

What is the management of chronic diverticular disease?

Answer 4

If certain of diagnosis and symptoms mild, can treat conservatively with:

• Lubricant laxative
• High-fibre diet

If symptoms severe or carcinoma cannot be excluded:
- Laparotomy and resection of sigmoid colon.

Question 5

What is the most likely cause of sudden, profuse, bright red rectal bleeding in an elderly pt?

Answer 5

Bleeding from a diverticulum

Often hypertensive