Diverticular Disease
Diverticulosis consists of small pockets of the inner lining (mucosa) of the colon. these can occur anywhere in the colon, but are more common in the sigmoid and left sided colon in Western populations.
The condition is generally thought to be due to low fibre diets of Western society. This leads to constipation, and slow transit of stool through the bowel.
The incidence increases with age.
The increased pressure in the bowel may be associated with spasm. Many of the diverticula contain a firm spherical pellet of faeces (faecolith) which is retained indefinitely in the “pocket”. This faecolith is probably the cause of inflammation which can lead to an abscess in the wall of the colon which in turn can cause acute abdominal infection (peritonitis) or later compression of the colon (stricture), or tunnel into another organ (fistula) such as bladder, bowel or vagina.
Most patients with diverticular disease have no symptoms, and may only be diagnosed with the disease as a result of an investigation of the bowel for other problems. Commo presenting symptoms include abdominal pain, perforation, abscesses, or bleeding. The disease may also present with fistulae between the bowel and bladder or vagina.
Diverticular disease can readily be diagnosed by endoscopy (flexible sigmoidoscopy or colonoscopy) or CT scan. Often these investigations are often carried out to differentiate the symptoms from other diseases such as colon cancer, or to ascertain the severity of the disease.
Treatment for patients with asymptomatic or mild disease may include a high fibre diet and sometimes aperients. If an attack is more severe oral or intravenous antibiotics are required. Repeated attacks of admissions may lead to colonic resection. If the disease is severe and does not respond to intravenous antibiotics, or there are other complications surgery is required.