Bowel

Diverticulosis

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Diverticulosis, Diverticular Disease, Diverticuli, Diverticula, Colonic Diverticuli

  • See Also
  • Epidemiology
  1. Rare in non-developed countries
  2. Prevalence
    1. Age over 40 years: 10%
    2. Age over 60 years: 50%
    3. Age over 80 years: 70%
  • Pathophysiology
  1. Characteristics
    1. Colonic muscle wall is weak where vessels penetrate
    2. Usually multiple Diverticuli present
    3. Size: Usually <10 mm
  2. Distribution
    1. Sigmoid colon
      1. Most common site for Diverticuli in western societies (accounts for 85% of Diverticuli)
    2. Ascending colon (right Diverticuli)
      1. Age <60 years
      2. Asian patients
  3. Protective factors
    1. Vegetarian diet
    2. High fiber diet
  • Symptoms
  1. Asymptomatic in 85% of patients
  2. Colicky Abdominal Pain without inflammation in 15%
    1. Relieved with Bowel Movement or Flatus
    2. Worse with eating
    3. Associated with bloating and Constipation
    4. Left lower abdominal tenderness to palpation
  3. Diverticulitis develops in 5% of patients
  • Diagnosis
  • Symptomatic Diverticular Disease
  1. Colonoscopy is test of choice
    1. Rules out Colon Cancer
    2. Contraindicated in active Diverticulitis
  • Management
  1. High fiber diet
  2. Avoid high residue foods (seeds, nuts, corn)
    1. Recommended theoretically to prevent lodging in tics
    2. No evidence to support this
  3. Antispasmodic agents have no evidence to support use
  • Complications