Diverticular disease

15 Diverticular disease





Questions



image What is the difference between diverticular disease and acute diverticulitis?

image What are the complications of diverticular disease?

image What is a Hartmann’s procedure?

Diverticular disease is a very common disorder in the West; 5% of those affected are in their fifties and 50% of people are over 70 years of age; 80% of diverticula are asymptomatic.




Pathology


A low-fibre diet leads to high luminal pressures, causing mucosa to herniate through the muscle layers to form pouches, called diverticula. Diverticula tend to occur in rows, commonly in the sigmoid colon (> 90%):


image diverticulosis: symptomless diverticula

image diverticular disease: diverticula cause symptoms in 10–25% of people, such as altered bowel habit or low-grade grumbling bowel pain; smoking and NSAIDs have been implicated in exacerbating complicated disease

image acute diverticulitis: if the diverticula become infected, secondary to occlusion of the orifice (as in appendicitis), the patient may present with severe abdominal pain, fever and localized or generalized abdominal sepsis


Clinical features


There is a wide variety of presentations:


image asymptomatic: only 20% are symptomatic; diverticula are identified on colonoscopic or barium examination

image abdominal pain: chronic, progressive lower abdominal or left iliac fossa pain is a common chronic presentation

image altered bowel habit: exclude colorectal cancer

image rectal bleeding (rare)

image pneumaturia: frothy urine, which is caused by colovesical fistula allowing air from the bowel to enter the bladder

image faeces per vaginum: usually after a previous hysterectomy forming a colovaginal fistula
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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Diverticular disease

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