Up ] Drainage of superficial and deep abscesses ] Abdominal trauma ] Splenic trauma ] Abdominal pain ] Abdominal incisions ] Abdominal masses ] Ovarian cysts ] Appendicitis ] Perforated peptic ulcer ] Mesenteric ischaemia ] Small bowel obstruction ] Large bowel obstruction ] Pseudo-obstruction ] Sigmoid and caecal volvulus ] Peritonitis ] Upper GI haemorrhage ] Lower GI haemorrhage ] Groin hernias ] Other hernias ] Enterocutaneous fistulae ] Stomas ] GORD ] Achalasia ] Oesophageal carcinoma ] Oesophageal perforation ] Gastric carcinoma ] Peptic ulcer disease ] Gastric volvulus ] Coeliac disease ] Jaundice ] Gall stones ] Acute pancreatitis ] Chronic pancreatitis ] Pancreatic cancer ] Pancreatic endrocrine tumours ] Hepatocellular carcinoma ] Cholangiocarcinoma ] Liver metastases ] Portal hypertension ] Ascites ] Pyogenic liver abscess ] Amoebic liver abscess ] Hydatid disease ] Inflammatory bowel disease ] Colonic polyps ] Colorectal carcinoma ] Pseudomyxoma ] [ Diverticular disease ] Rectal prolapse ] Haemorrhoids ] Anal fissure ] Perianal sepsis ] Anal carcinoma ] Pilonidal sinus ] Breast assessment ] Breast imaging ] Benign breast disease ] Breast pain ] Fibroadenoma ] Breast cysts ] Breast sepsis ] Nipple discharge ] Gynaecomastia ] Breast cancer ] Breast reconstruction ] Cancer genetics ] Hypercalcaemia ] Parathyroid ] Multiple endocrine neoplasia syndromes ] Carcinoid tumours ] Arterial assessment ] Abdominal aortic aneurysm ] Aortic dissection ] Peripheral vascular disease ] Acute limb ischaemia ] Diabetic foot ] Amputations ] Carotid artery disease ] Vascular trauma ] Varicose veins ] Venous hypertension ] Venous thrombosis ] Raynaud's disease ] Lymphoedema ] Lymphadenopathy ] Hodgkin's disease ] The spleen ] Thyroglossal cysts ] Cushing's syndrome ] Thyrotoxicosis ] Goitre ] Thyroiditis ] Thyroid nodules ] Thyroid tumours ] Hypertension ] Conn's syndrome ] Phaeochromocytoma ] Adrenal incidentalomas ]

Diverticular disease

  • Colonic diverticulae are outpouchings of colonic wall
  • Usually result from herniation of mucosa through muscular wall
  • Occur at sites where mesenteric vessels penetrate the bowel wall
  • Most common in sigmoid colon
  • Increased prevalence with age 
  • 10% population at 40 years
  • 60% population at 80 years
  • More common in developed countries

Aetiology

  • Due to lack of dietary fibre in Western diets
  • Low dietary fibre results in low stool bulk
  • Induces increased segmentation of colonic musculature resulting in hypertrophy
  • Increased intraluminal pressure results in herniation

Complications

  • Diverticulitis
  • Pericolic abscess
  • Purulent peritonitis - due to rupture of pericolic abscess
  • Faecal peritonitis - due to free perforation of diverticulum
  • Fistula - to vagina, bladder, skin
  • Colonic stricture

Perforated sigmoid diverticulum

Operative appearance of a colonic diverticulum

Picture provided by Josi Garcia, Tampico, Mexico

Diverticular perforation

Picture provided by Colm O'Boyle, Hull Royal Infirmary, United Kingdom

Investigation

  • Plain X-rays with positive diagnostic features (e.g. free gas, gas in bladder) are useful
  • Normal X-rays can not exclude complications of diverticular disease
  • Double contrast barium enema - allows diagnosis, assessment of extent and complications
  • CT +/- intravenous and rectal contrast - useful for imaging abscesses, fistulae

Treatment

  • Bowel rest by restricting oral intake and intravenous fluids
  • Intravenous antibiotics - 2nd generation cephalosporin (e.g. cefuroxime) and metronidazole
  • Active observation for the development of complications
  • If abscess formation - percutaneous drainage under radiological guidance usually possible
  • Subsequent elective resection and primary anastomosis often required

Bibliography

Ambrossetti P.  Diverticulitis of the left colon.  In:  Johnson C D,  Taylor I eds.   Recent advances in surgery 20.  Churchill Livingstone 1997:  145-160.

Ferzoco L B,  Raptopoulos V,  Silen W.  Acute diverticulitis.  N Eng J Med 1998;  338:  1521-1526.

Jones S E J,  Meagher A,  Fizelle F A.  Management of diverticulitis.  BMJ 2006;  332:  271-275.

McKee R F et al.  Radiological investigation in acute diverticulitis.  Br J Surg 1993; 80: 560 - 565.

Paterson-Brown S.  The use of laparoscopy in the acute abdomen.  Curr Pract in Surg 1993; 5: 207 - 210.

Simpson J,  Scholefield  J H,  Spiller R C.  Pathogenesis of colonic diverticula.  Br J Surg 2002;  89:  546-554.

Stollman N,  Raskin J B.  Diverticular disease of the colon.  Lancet 2004;  363:  631-639.

 

 
 

Last updated: 03 January 2011

Copyright 1997- 2011 Surgical-tutor.org.uk