Diverticulitis/Diverticular Disease

This is a common condition in our community (affecting over 50% of those over 60 years old). The colon develops weak areas in its wall which form diverticula or pockets. The sigmoid colon is the area most frequently affected and is the site of most complications.

The cause has been attributed to a chronic low fibre diet leading to increases in pressure within the colon to generate progression of stool.

Symptoms:

The condition should not cause symptoms. Left sided abdominal pain and altered bowel habits may be early symptoms. Complications cause their own specific symptoms.

Complications:

  • Inflammation-Diverticulitis - causes left sided abdominal pain, and fevers
  • Perforation - can cause sudden severe pain and collapse. This is a surgical emergency and hospital treatment should be obtained immediately
  • Abscess - caused by a localised perforation causes ongoing pain and fevers, may cause urinary frequency and a mass can sometimes be felt.
  • Fistulae - can occur especially to the bladder which may cause urinary infection or gas in the urine. In the female fistulae to the vagina can also occur causing gas and faeces to pass from the vagina.
  • Large Bowel Obstruction - if scarring and muscle thickening is severe the inside can narrow and obstruct causing pain and distension.
  • Bleeding - can be severe from diverticla openings and generally requires in-hospital treatment and resuscitation.

Investigations:

  • Colonoscopy: often performed, diverticula openings can be seen.
  • Barium enema:(X-Ray with dye and air inserted into rectum) gives a good outline of the diverticula and can show stricturing of the bowel.
  • CT Scan: Can outline any mass(abscess) outside the bowel
  • Nuclear Medicine Red Blood Cell Labelled scan: to localise bleeding point
  • Angiogram: To localise bleeding point
  • CT Angiogram: To localise bleeding point.

Treatment:

High fibre diet is the only treatment that can be offered in the setting outside acute complications

Acute infections require antibiotics and usually hospital-based observation.

Complications aside from haemorrhage generally require surgical excision of the affected segment of bowel, which can be done with open or laparoscopically assisted techniques.

Related Links:

www.fascrs.org/patients/conditions/diverticular_disease/
www.cssanz.org/index.php/patients/diverticular-disease