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Diverticular disease

Definition
  • Condition characterised by small pouches (diverticula) that bulge outward through weak spots in the colon wall.
Epidemiology
  • 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.
Types
  • Diverticulosis: Presence of diverticula without symptoms.
  • Diverticular disease: Symptomatic diverticulosis without inflammation.
  • Diverticulitis: Inflammation and/or infection of the diverticula.
Clinical Features
  • 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.
Investigations
  • 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.
  • FBC: Leucocytosis in diverticulitis.
Management
  • 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.
Complications
  • Abscess formation.
  • Perforation leading to peritonitis.
  • Fistula formation.
  • Intestinal obstruction.
  • Pericolic haematoma.

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