Definition

Diverticula are small out pocketings of the wall of the colon (large bowel) which occur when the lining of the bowel pushes out between the surrounding muscle layers to form small bubbles or balloonings which are blind ended. These little pockets can become inflamed, a condition known as diverticulitis.
The term diverticulosis indicates that the small pockets are present. Diverticular disease is probably related to a low fibre diet and constipation will contribute to it.

Incidence

Diverticula are found in 50% of patients over the age of 50 years but they are asymptomatic in 90% of patients and are discovered incidentally on investigating the large bowel.

Causes/Prevention

A low fibre diet seems to contribute and increasing dietary fibre and bulking agents may help prevent the condition.

Signs & Symptoms

Left iliac fossa pain and constipation are often attributed to diverticular disease but are more likely to be due to irritable bowel syndrome. The main problem with diverticular disease are its complications.

Complications of Diverticular Disease

Acute diverticulitis - This occurs when faeces obstruct the neck of a diverticulum causing stagnation and allowing multiplication of bacteria and inflammation. Pain in the left lower part of the abdomen, often with fever and constipation occurs. This is often termed “left sided appendicitis”.

Acute diverticulitis can lead to abscess formation, perforation and peritonitis and erosion into the bladder causing a fistula which is a connection between the bowel and the bladder. Occasionally a diverticula abscess can cause a blockage or obstruction of the bowel.

A further complication of diverticular disease is rectal bleeding which can be very brisk and hard to locate.

Tests

Diverticular disease may be seen on barium enema, a procedure where barium liquid is passed into the bowel via a rectal tube. Air is then pumped into the bowel to allow the bowel outline to be shown up on X-ray.

This will usually show the small out pocketings known as diverticula. A second way of diagnosing the disorder is on colonoscopy, where a fibre optic tube is passed through the rectum and into the bowel and a picture of the bowel lining can be displayed via a video camera to a TV screen.

Treatment

In mild cases the treatment is that of constipation, i.e. laxatives and bulking agents together with antispasmodic drugs, such as Mebeverine or Alverine citrate.

Acute diverticulitis is treated with antibiotics, intravenous fluids and bowel rest. Where abscess formation, perforation or obstruction are suspected then surgery may be necessary to remove the diseased segment.


Source: www.privatehealth.co.uk
Last Editorial Review: 18/1/2010