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Diverticulosis

Diverticulosis is a topic covered in the 5-Minute Emergency Consult.

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Emergency Central

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Basics

Description

  • Single (diverticulum) or multiple (diverticula) colonic wall outpouchings from colonic muscle dysfunction, usually acquired
  • Sequence:
    • Insufficient amounts of dietary fiber cause diminished stool bulk
    • Increased colonic contractions to propel stool through colon cause increase in intraluminal pressure
    • Increased pressure forces mucosa and submucosa to herniate through muscularis propria at its weakest point, where vasa recta penetrate

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, owing to refined diet and low intake of fiber
  • Prevalence is age-dependent
    • 30% by 50 yr old, 65% by 85 yr old
  • Complications
    • 70% are asymptomatic
    • 15–25% 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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Citation

Rosen, Peter, et al., editors. "Diverticulosis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307445/all/Diverticulosis.
Diverticulosis. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307445/all/Diverticulosis. Accessed April 25, 2019.
Diverticulosis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307445/all/Diverticulosis
Diverticulosis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307445/all/Diverticulosis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Diverticulosis ID - 307445 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307445/all/Diverticulosis PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -