Diverticular Disease

Question 1

What is diverticular disease?

Answer 1

Symptomatic diverticula

Question 2

What is a diverticulum?

Answer 2

Outpouching of the bowel wall.

Most commonly found in the sigmoid colon

Question 3

What is diverticulosis?

Answer 3

Presence of diverticula

Question 4

What is diverticulitis?

Answer 4

Inflammation of the diverticula

Question 5

What is a diverticular bleed?

Answer 5

Diverticulum erodes into a vessel and causes a large volume painless bleed

Question 6

Pathophysiology of diverticular disease

Answer 6

Aging bowel weakened over time
Movement of stool increases intraluminal pressure
Outpouching of the mucosa through weakened areas

Bacteria can overgrow in diverticula

Question 7

Risk factors for diverticular disease

Answer 7

Low dietary fibre
Obesity
Smoking
Family history
NSAID use

Question 8

Clinical features of diverticular disease

Answer 8

Most people with diverticulosis remain asymptomatic

Diverticular pain

• colicky lower abdominal pain
• altered bowel habit
• nausea
• flatulence

Question 9

Clinical features of diverticulitis

Answer 9

Acute abdominal pain - usually localised to LIF
Localised tenderness
Decreased appetite 
Fever
Nausea

Question 10

Investigations for suspected diverticular disease

Answer 10

Bloods
Urinalysis - exclude urological causes
Flexible sigmoidoscopy
CT abdo-pelvis

Question 11

What is the Hinchey Classification?

Answer 11

Staging for acute diverticulitis - based on CT findings

Stage 1a - Phlegmon (inflammation of soft tissues)
Stage 1b - diverticulitis with pericolic or mesenteric abscess
Stage 2 - diverticulitis with walle off pelvic abscess
Stage 3 - diverticulitis with generalised purulent peritonitis
Stage 4 - diverticulitis with generalised faecal peritonitis

Question 12

Management of diverticular disease

Answer 12

Most cases managed with fluids and analgesia

Conservative management (diverticultis)

• IV antibiotics
• IV fluids
• bowel rest

Surgical management ( perforation)
- Hartmann's procedure ( sigmoid colectomy with formation of end colostomy)

Question 13

Complications of diverticular disease

Answer 13

Pericolic abscess
- antibiotics + bowel rest

Fistula formation

• colovesical fistula (pneumoturia, faecal matter in urine, recurrent UTIs)
• colovaginal fistula (vaginal discharge, recurrent vaginal infections)

Bowel obstruction
- secondary to stricture formation