Diverticular Disease

Mucosal herniation through muscle coat, most commonly in the sigmoid colon

Aetiology

  • The main risk factors are age over 50 years and low dietary fibre

Pathophysiology

  • In the presence of a lack of fibre, the muscles of the colon must work harder to move faeces along
  • This causes very high pressures in the colon, and as a result some parts of the mucosa will form out-pouchings
notion image

Clinical presentation

  • Approximately 75% of people with diverticula have asymptomatic diverticulosis
  • When cause symptoms - left iliac fossa pain/tenderness, altered bowel habit
  • Of the 25% of people with diverticula who develop symptomatic diverticular disease, approximately 75% will have at least one episode of diverticulitis (diverticular inflammation - see notes)

Investigations

  • Barium enema
  • Sigmoidoscopy if inconclusive

Management

Asymptomatic

  • Recommend high fibre diet and high fluid intake

Symptomatic

  • Analgesics
  • Laxatives if necessary (avoid stimulant laxatives)
  • Severe - surgical resection of sigmoid colon