What is diverticular disease?

Diverticular disease is a benign colonic condition where small pockets (diverticula) can bulge out of the colon through areas of weakness in its wall. When these diverticula become infected the condition is known as diverticulitis

Diverticular disease is very common. About a third of Australians over the age of 50 would have some diverticular disease, many are unaware of it. Diverticular disease is rare before the age of 30.

Low fibre diet is considered the main risk factor for diverticular disease. Low fibre predisposes to constipation and harder small volume stool which requires more colonic pressure to propel it down stream. High intra-colonic pressure results in “blow outs” of pouches through weakness areas in the colon.

What are the symptoms of diverticular disease?

Most people with diverticular disease are not aware they have it. Some may have vague symptoms of abdominal cramps, bloating, constipation of diarrhoea.

Diverticular bleeding – This occurs when a blood vessel in the diverticulum is eroded. They often cause painless rectal bleeding and can be significant enough to require hospitalisation. However, bleeding often ceases without intervention. If bleeding persists then angiography and embolization (plugging the bleeding vessel with the help of radiology) may be required

Diverticulitis – This occurs when there is inflammation in the diverticula and can be simple or complicated

Simple diverticulitis presents with abdominal pain mainly in the left lower quadrant of the abdomen and could be associated with fever. This almost always responds to antibiotics

What are the possible complications of diverticulitis?

  • Perforation – Inflammation of the colonic diverticulum may lead to a blow out of the diverticulum and leakage of faecal material into the abdominal cavity and cause severe infection that may require surgical intervention
  • Fistula – A fistula is a communication between the colonic lumen and another organ most commonly the bladder or the vagina in women
  • Stricture – A stricture is a narrowing the colonic lumen that could lead to blockage in the bowel that requires urgent surgery

What’s the treatment for diverticulitis?

CT is required to diagnose diverticulitis and to determine if it simple or complicated diverticulitis. Most cases of simple diverticulitis respond to antibiotics. Occasionally, Colonic perforation causes an intra-abdominal abscess that may need drainage under the guidance of x-rays (CT).

Patients that do not respond to antibiotics or who are very unwell on admission may need surgery to resect the perforated segment of the colon. A stoma is often necessary as the bowels are not suitable for joining at the time of surgery. Occasionally, when the contamination is minimal and the patient’s condition is favourable, joining the bowels after resection can be achievable depending on the expertise of the surgeon.