What is diverticular disease?
- Diverticula are pouches or pockets that bulge out from the walls of the intestine
- Diverticulosis is when these diverticula are picked up incidentally on imaging, but they do not cause any symptoms
- Diverticulitis is when the diverticula become inflamed and cause symptoms
A common risk factor for diverticulosis is chronic constipation as the the stool increases the intraluminal pressure and increases the risk of developing diverticula.
Risk factor for diverticulitis is pre-existing diverticulosis. Often times when patients get a colonoscopy, they are not informed that they have diverticula by the general surgeon. As a family doctor it is important to make sure that the patient knows that they have diverticula so if they even develop diverticulitis, they can tell the ER doc that they have diverticulosis, so that the diagnosis of diverticulitis does not get missed.
Symptoms?
- Diverticulosis – asymptomatic
- Diverticulitis
- Common cause for left lower quadrant pain as it commonly affects the sigmoid colon
- Constipation and/or diarrhea
- Stool becomes stuck in diverticula causing bowel obstruction
- Urinary symptoms due to enlarged sigmoid colon
Diagnosis
- Acute
- First line: abdominal CT
- Second line: abdominal ultrasound
- Incidental finding
- Colonoscopy (do not perform if there is acute diverticulitis)
Treatment
- Oral antibiotics (amoxclav, septra + metronidazole, ciprofloxacin + metronidazole) for 7-10 days for uncomplicated diverticulitis
- Broad spectrum IV antibiotics with transition to oral antibiotics if symptoms improve
- CT-guided percutaneous abscess drainage may be required in acute complicated cases
- Surgery may be needed for management of structural complications or for emergent cases
Complications
- Diverticular bleeding (could be painless)
- Abscess (suspect if pain and fever is not relieved with antibiotics)
- Perforation (when diverticula perforates due to increasing intraluminal pressure)
- Fistula (inflammation causes connection between colon and bladder i.e. colovesical fistula, suspect if there is pneumaturia and fecaluria)
- Intestinal obstruction (abdominal distension, nausea, vomiting)