II. Definitions
- Diverticulum (Diverticula, Diverticuli)
- Small pouch or sac that bulges from the wall of a hollow organ (e.g. Colonic Diverticuli)
- Diverticulosis
- Colonic Diverticula present on Colonoscopy or imaging
- Acute Diverticulitis
- Inflammation of a Diverticulum
III. Epidemiology
- Attributed to the low fiber diets in developed countries
- Rare in non-developed countries, where fiber intake is higher
- Diverticulosis Prevalence
- Age over 40 years: 10%
- Age over 60 years: 50%
- Age over 80 years: 50 to 70%
IV. Pathophysiology
- Low fiber diet predisposes to small stools, straining and increased bowel luminal pressures
- Characteristics
- Colonic Muscle wall is weak where vessels penetrate
- Large Bowel submucosa Herniates through the bowel's muscular layer
- Diverticuli develop with patient's age
- Usually multiple Diverticuli present
- Size: Usually <10 mm
- Colonic Muscle wall is weak where vessels penetrate
- Distribution
- Sigmoid colon
- Most common site for Diverticuli in western societies (accounts for 85% of Diverticuli)
- Ascending colon (right Diverticuli)
- Age <60 years
- Asian patients
- Sigmoid colon
- Protective factors
- Vegetarian Diet
- High fiber diet
V. Symptoms
- Asymptomatic in 85% of patients
-
Colicky Abdominal Pain without inflammation in 15%
- Relieved with Bowel Movement or Flatus
- Worse with eating
- Associated with bloating and Constipation
- Left lower abdominal tenderness to palpation
- Diverticulitis develops in 5% of patients
VI. Differential Diagnosis
VII. Diagnosis: Symptomatic Diverticular Disease
-
Colonoscopy is test of choice
- Rules out Colon Cancer
- Contraindicated in active Diverticulitis
VIII. Management
- High fiber diet
- Avoid high residue foods (seeds, nuts, corn)
- Recommended theoretically to prevent lodging in tics, but has been dispelled as a risk factor
- No evidence to support this
- Antispasmodic agents have no evidence to support use
IX. Complications
-
Diverticulitis
- Incidence 1.5 to 6 per 1000 person years for those with Diverticula
- Affects 1 to 4% (up to >10% in some studies) of patients with Diverticular Disease (lifetime risk)
-
Diverticular Hemorrhage
- Incidence 0.46 per 1000 person years for those with Diverticula
- Most common cause of Lower Gastrointestinal Bleeding