Colonic diverticulosis

Abstract

Colonic diverticulosis is small outpouchings from the colonic lumen. Prevalence of diverticulosis increases with age and there is considerable geographic variation. Diverticulosis is seen mainly in the distal colon in western populations, whereas right-sided involvement is more prominent in Asia. Most patients with diverticulosis coli will remain asymptomatic and the diagnosis is frequently an incidental finding. Symptoms of uncomplicated diverticular disease are non-specific and similar to those of irritable bowel syndrome. Acute diverticulitis is the commonest complication of diverticular disease, affecting up to 25% of patients. Patients should be treated with bowel rest, analgesia and appropriate antibiotics (i.v.). Diverticular perforations may be contained locally as peridiverticular, mesenteric or pericolic abscesses. Small pericolic abscesses can often be treated conservatively. Larger abscesses may be drained percutaneously under ultrasound or CT guidance. Some abscesses are not amenable to, or fail to settle with, percutaneous drainage and surgery is indicated. Perforation into the peritoneal cavity causes purulent or faecal peritonitis with the attendant signs of shock. Patients require active resuscitation before emergency laparotomy. A fistula can result if a phlegmon or diverticular abscess extends or ruptures into an adjacent organ. Other complications include obstruction of the small or large bowel, and rectal bleeding.