- 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
- 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
- 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
Picture provided by Josi Garcia, Tampico, Mexico
Picture provided by Colm O'Boyle, Hull Royal Infirmary, United Kingdom
- 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
- 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
Diverticulitis of the left colon.
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