Diverticular disease

Condition characterised by small pouches (diverticula) that bulge outward through weak spots in the colon wall.

• Common in Western countries, especially with increasing age (up to 50% of those over 70 years may have it).
• Higher incidence in individuals with a low dietary fibre intake.

• Diverticulosis: Presence of diverticula without symptoms.
• Diverticular disease: Symptomatic diverticulosis without inflammation.
• Diverticulitis: Inflammation and/or infection of the diverticula.

• Diverticulosis is often asymptomatic; found incidentally on imaging.
• Diverticular disease may present with:

• • Intermittent lower abdominal pain (usually left-sided).
  • Altered bowel habits.
  • Bloating.

• Diverticulitis typically presents with:
  • Constant left-sided abdominal pain.
  • Fever.
  • Elevated white blood cell count.
  • Nausea and vomiting.

• Colonoscopy: Diagnostic tool of choice but should be avoided during acute diverticulitis due to perforation risk.
• Abdominal CT scan: Useful for diagnosing diverticulitis and its complications.
• Barium enema: Less commonly used but can show diverticula.
• Full Blood Count: Leucocytosis in diverticulitis.

• Diverticulosis and diverticular disease: Dietary advice, especially increasing fibre intake.
• Diverticulitis:

• • Mild: Oral antibiotics (e.g., amoxicillin-clavulanate) and dietary modification (clear fluids).
  • Severe or complications: Hospital admission, IV antibiotics, and possibly surgical intervention.

• Surgery: Indicated for recurrent episodes, complications (abscess, fistula, obstruction), or severe attacks.

• Abscess formation
• Perforation leading to peritonitis
• Fistula formation
• Intestinal obstruction
• Pericolic haematoma