Diverticulosis and Diverticulitis

Background of diverticular disease

Diverticulosis and Diverticulitis

Type

Clinical features

Definitions

Diverticulum

- Protrusion of colonic wall that forms a sac

- Abnormal colonic motility exaggerates segmental contractions

- Increase in intraluminal pressure leads to herniation of mucosa and submucosa

Diverticulosis

- Up to 45% prevalence in Western countries

- Presence of many diverticula that can be asymptomatic or symptomatic

- Most commonly in sigmoid colon

- Easily visualized on colonoscopy

Diverticular disease

- Clinically significant and symptomatic diverticulosis

- Diverticular bleeding

- - Painless blood in stool

- - Herniation of diverticulum leads to injury of surrounding vasa recta

- - Artery weakens and ruptures into lumen

- Diverticulitis

- - Occurs in approximately 4-15% of patients with diverticulosis

- - Inflammation of diverticulum that can be acute/chronic and uncomplicated/complicated

- - - Erosion of diverticular wall due to increased intraluminal pressure

- - - Eventual inflammation, necrosis, and micro/macro perforation

- - Complicated

- - - Diverticular abscess

- - - Fistula

- - - Bowel obstruction

- - - Free perforation

- Segmental colitis

- - Inflammation of mucosa between diverticulum without involvement of the diverticular orifice

- - Unclear pathogenesis but possible mucosal prolapse, fecal stasis, or localized ischemia

- Symptomatic uncomplicated diverticular disease (SUDD)

- - Persistent abdominal pain without macroscopically visible colitis or diverticulitis

- - Colonic wall thickening without other inflammatory changes on CT imaging

- - Possibly due to abnormal colonic motility or visceral hypersensitivity

Risk factors

Decreased physical activity

Obesity

Smoking

Dietary

- Low fiber

- High fat

- High red meat intake

Medications

- Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

- Steroids

- Opiates

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