• 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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