Bowel

Diverticulosis

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Diverticulosis, Diverticular Disease, Diverticuli, Diverticulum, Diverticula, Colonic Diverticuli

  • Definitions
  1. Diverticulum (Diverticula, Diverticuli)
    1. Small pouch or sac that bulges from the wall of a hollow organ (e.g. Colonic Diverticuli)
  2. Diverticulosis
    1. Colonic Diverticula present on Colonoscopy or imaging
  3. Acute Diverticulitis
    1. Inflammation of a Diverticulum
  • Epidemiology
  1. Rare in non-developed countries
  2. Diverticulosis 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, but has been dispelled as a risk factor
    2. No evidence to support this
  3. Antispasmodic agents have no evidence to support use
  • Complications
  1. Diverticulitis
    1. Incidence 1.5 to 6 per 1000 person years for those with Diverticula
    2. Affects 1 to 4% of patients with Diverticular Disease (lifetime risk)
  2. Diverticular Hemorrhage
    1. Incidence 0.46 per 1000 person years for those with Diverticula
    2. Most common cause of Lower Gastrointestinal Bleeding