Diverticulosis

Question 1

What is diverticular disease?

Answer 1

Diverticular disease is asymptomatic in many patients and is often an incidental finding on other investigations. While a good history is often sufficient to form a diagnosis of Diverticular disease, it is important to exclude other pathology in the presence of bleeding and alteration of bowel habits.

The commonest site is the sigmoid colon – possibly due to the pressure effects associated with chronic constipation and/or accumulation of faecal matter.

Question 2

What are the risk factors fro diverticular disease?

Answer 2

• Chronic constipation
• Hereditary factors
• High intake of meat and red meat
• Increasing age

Question 3

What are the frequent complications associated with diverticuli?

Answer 3

1. Infection resulting in diverticulitis. Clinical presentation will be very similar to acute appendicitis but pain is frequently located in the left side of the abdomen or the hypogastrium.
2. Bleeding- occult or overt
3. Perforation (very serious - due to possible leakage of faeces giving rise to faecal peritonitis)
4. Abscess formation: Diverticular abscess similar to appendicular abscess.

Question 4

What is the difference between diverticulosis, diverticular disease, and diverticulitis?

Answer 4

Diverticulosis = Diverticula are present

Diverticular disease
= Symptomatic

Diverticulitis = Inflammation of a diverticulm

Question 5

How does diverticulitis present?

Answer 5

Pyrexia, altered bowel habit, left-sided colic pain relieved by defecation, nausea, flatulence.

Increased WCC, CRP/ESR,

Question 6

How is diverticulitis managed?

Answer 6

Mild attacks can be treated at home with bowel rest (fluids only_, +/- antibiotics

Analgesia, NBM, and IV fluids

Imaging: erect CXR + USS

Question 7

What are the complications of diverticulitis?

Answer 7

Perforation = ileus, peritonitis + shock. Mortality is 40%. Manage as for an acute abdomen. at laparatomy a hartmann’s procedure may be performed

Haemorrhage= usually sudden and painless. It is a common cause of a big rectal bleed Bleeding usually stops with bed rest. Transfusion may be needed. Embolisation or colon resection may be necessary after location bleeding points by angiograph or colonoscopy.

Fistulae= Enterocolic, colovaginal, colovesical. Colonic resection