Diverticulosis

Basics

Description

  • Single (diverticulum) or multiple (diverticula) colonic wall outpouchings from colonic muscle dysfunction, usually acquired
  • Broadly divided into the following categories:
    • Asymptomatic diverticulosis
    • Symptomatic uncomplicated diverticular disease (SUDD)
    • Segmental colitis associated with diverticulosis
    • Diverticulitis (uncomplicated or with complications)

Etiology

  • Occurs anywhere in GI tract, although generally a colonic disease:
    • Left sided: 95% (Western countries)
    • Right sided: 70% (Asian countries)
    • Sigmoid colon most common site
  • Pseudodiverticula:
    • Outpouchings of mucosa and submucosa only
    • Most common form of colonic diverticula
    • True congenital diverticula (uncommon) contain all bowel wall layers
  • Common in Western society
  • Multifactorial: genetics and lifestyle factors implicated
  • SUDD thought to have overlap with irritable bowel syndrome in etiology
  • Prevalence is age dependent:
    • 50% by age 60, 70% by age 80
    • Affects men and women equally
  • Complications:
    • 70% are asymptomatic
    • <5% develop diverticulitis
    • 5–15% develop bleeding; obesity is a risk factor:
      • Bleeding stops spontaneously in 75% of cases
    • Inflammation (diverticulitis)
    • Massive arterial bleeding usually from right colon:
      • Fecalith (dry, hard stool) erodes through arterial branch
    • Perforation
    • Abscess
    • Obstruction

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