Chapter 34 - Acute diverticulitis

Abstract

Diverticular disease is the most common benign disorder of the colon. Diverticula are saccular outpouchings of the colonic mucosa/submucosa through interruptions of the muscular layer where the vasa recta penetrate the circular muscle layer. The prevalent etiopathogenic theory for diverticular formation is that of chronically increased colonic intraluminal pressures resulting from a low-fiber, Western-type diet. A nondietary theory postulates that colonic segmentation during peristalsis may lead to high endoluminal pressure areas, thus causing mucosal herniation through the muscularis. The frequency of diverticular formation increases with age. In Western populations, the sigmoid colon is affected most frequently. In Far Eastern populations, right-sided diverticulosis is more prevalent. In addition, the incidence of diverticular disease has increased in populations which have adopted a Western-type diet. The two manifestations of diverticular disease are acute diverticulitis and diverticular bleeding. Clinically, acute diverticulitis presents with gradual onset of left-sided abdominal pain. Pain is continuous, may be associated with constipation or diarrhea, and fever is frequent. The treatment for acute diverticulitis includes treatment with or without antibiotics, interventional radiological procedures, minimally invasive or open surgery with or without resection, with or without creation of a stoma.