Diverticular Disease

DEFINITIONS

A diverticulum is a sac-like protrusion that forms in the muscular wall of the colon, particularly at points where blood vessels enter. The pleural of diverticulum is diverticula . Diverticular disease of the colon refers to diverticulosis, diverticulitis, and diverticular bleeding. Diverticulosis is the disease where multiple diverticula are present within the colon. Diverticulitis means that the diverticula are inflamed or infected. Diverticular bleeding refers to one diverticulum actively losing blood.

DIVERTICULOSIS

Diverticulosis occurs mostly in older adults, and is a normal part of aging. Typical low fiber American diets, as well as one’s family history, also affect the likelihood of developing diverticulosis. Diverticulosis alone probably does not cause any symptoms, such as pain or alteration of bowel function. Diverticulosis is usually diagnosed incidentally in people undergoing colonoscopy, barium enema, and other tests for unrelated reasons. Your doctor may ask you to increase the amount of daily fiber in an attempt to prevent further diverticula from developing.

DIVERTICULITIS

Although many adults have diverticulosis, a relatively small number ever develop diverticulitis. Diverticulitis typically presents with acute abdominal pain, constipation, and fever. It usually is not associated with bleeding. Diverticulitis can be triggered by ingestion of high “residue” foods, such as seeds, nuts, and popcorn, as well as by anti-inflammatory drugs (ibuprofen, naprosyn, aspirin). It usually responds well to antibiotics and dietary modifications. Surgery is usually reserved for cases of diverticulitis that do not respond to antibiotics or for recurrent cases of infection. On occasion, an episode of diverticulitis will lead to infection of the whole abdomen, known as peritonitis, which requires surgery to correct. Diverticulitis can be diagnosed on the basis of symptoms, physical examination and blood tests, as well as with imaging studies such as CT scans.

DIVERTICULAR BLEEDING

Diverticular bleeding can be mild or life threatening and may require hospitalization. Most cases of diverticular bleeding resolve without any specific therapy. However, some patients have continued bleeding that requires colonoscopy, nuclear medicine scans or angiography in an attempt to stop or slow the bleeding. When bleeding continues, surgery may be recommended.