Diverticulitis

Basics

Micro- or macroscopic perforation of diverticulum:
- Uncomplicated (75%) vs. complicated (25%)
Increased incidence:
- Increased diverticular disease = increased diverticulitis
- Increased incidence attributed to increased prevalence of western diet

Fecal material in diverticulum hardens, forming fecalith, increasing intraluminal pressure
Erosion of diverticular wall leads to inflammation and bacteria translocation
Focal necrosis leads to perforation
Microperforation: Uncomplicated diverticulitis:
- Colonic wall thickening
- Inflammatory changes (fat stranding on CT)
Macroperforation: Complicated diverticulitis:
- Abscess
- Bowel obstruction
- Fistulas after recurrent attacks
- Colovesical fistula (most common) presents with dysuria, frequency, urgency, pneumaturia, and fecaluria
- Peritonitis

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