Diverticular Disease

Diverticulosis is the presence of diverticular (outpouchings of the mucosa and submucosa, typically affecting the sigmoid colon). It forms from 2 main mechanisms:

• Raised intra-luminal pressure due to Low fibre diet - Movement of these faeces requires a lot more muscular effort → Smooth muscle hypertrophy → Raised intra-luminal pressure

• Areas of weakness in colonic wall - there are natural defects in the circular muscle layer where blood vessels pass through to supply the mucosal layer

Patients are typically asymptomatic, but can have constipation, LLQ pain, and PR bleeding.

Before a diagnosis, biopsies have to be taken as it can mimic colorectal cancer, therefore it will need to be ruled out.

Diverticulitis:

Presentation - LLQ pain and tenderness, Diarrhoea, Fever, N+V

Complications:

• Short-term

  • Abscess - Managed with bowel rest, Abx ± drainage

  • Perforation - Presents peritonitic, and is a surgical emergency

• Long-term

  • Fistula - Most commonly colovesical, presenting with pneumaturia, faecaluria, and recurrent UTIs

  • Stricture

  • Large bowel obstruction

Management:

Conservative - High-fibre diet

In hospital:

• NBM

• IV Abx and Fluids

• Analgesia

• Urgent investigations or surgery