DR MONIQUE MARAIS

GASTROENTEROLOGIST CAPE TOWN

DR MONIQUE MARAIS

GASTROENTEROLOGIST CAPE TOWN

Diverticular Disease

A diverticulum is an out-pouching that can form in the muscular wall of the colon. Diverticular disease is a term used to describe the condition of having these colon diverticulae.

Diverticular disease is a common problem that affects both men and women. The risk of disease increases with age.

Diverticular Disease

A person with diverticular disease may have diverticulosis, diverticulitis, or diverticular bleeding.

Diverticulosis

Diverticulosis is often found with a test done for other reasons, such as colonoscopy. Diverticulosis is an asymptomatic condition and patients remain symptom free for the rest of their lives.

Diverticulitis

This is inflammation of a diverticulum and occurs when there is thinning of the diverticular wall. This may be caused by increased pressure within the colon or when small particles of stool become lodged within the diverticulum. Both of these events probably decrease blood flow to the diverticulum. The symptoms of diverticulitis depend upon the degree of inflammation present. The most common symptom is pain in the left lower abdomen. Other symptoms can include nausea and vomiting, constipation, diarrhea, and urinary symptoms.

Diverticulitis is divided into simple and complicated forms: Simple diverticulitis, which accounts for 75% of cases, is not associated with complications and typically responds to medical treatment without surgery. Complicated diverticulitis occurs in 25% of cases and usually requires surgery.

Complications associated with diverticulitis can include the following:

Diverticular bleeding

Diverticular bleeding occurs when a small artery located within the diverticulum starts to bleed. This type of bleeding usually causes painless bleeding from the rectum. In about 50% of cases, the person will see maroon or bright red blood with bowel movements.

Diagnosis of diverticular disease

Treatment of diverticular disease

Diverticulosis

People with diverticulosis who do not have symptoms do not require treatment. However, most clinicians recommend increasing fibre in the diet by eating more fruit and vegetables, which can help to bulk the stools and possibly prevent the development of new diverticula, diverticulitis, or diverticular bleeding. However, fibre is not proven to prevent these conditions. Patients with diverticular disease have historically been advised to avoid whole pieces of fibre (such as seeds, corn, and nuts) because of concern that these foods could cause an episode of diverticulitis. However, this belief is completely unproven. We do not suggest that patients with diverticulosis avoid seeds, corn, or nuts.

Diverticulitis

Treatment of diverticulitis depends upon how severe your symptoms are. Home treatment - If you have mild symptoms of diverticulitis (mild abdominal pain, usually left lower abdomen), you can be treated at home with a clear liquid diet and oral antibiotics. However, if you develop one or more of the following signs or symptoms, you should seek immediate medical attention:

Hospital treatment For moderate to severe symptoms, you may be hospitalized for treatment. During this time, you are not allowed to eat or drink; antibiotics and fluids are given into a vein. If you develop an abscess, severe bleeding or blockage of the colon, you may require surgery

After an episode of diverticulitis resolves, the entire length of the colon should be evaluated to determine the extent of disease and to rule out the presence of abnormal lesions such as polyps or cancer. Recommended tests include colonoscopy, barium enema and sigmoidoscopy, or CT colonography.

Most cases of diverticular bleeding resolve on their own. However, some people will need further testing or treatment to stop bleeding, which may include a colonoscopy, angiography, or surgery.

Prognosis of diverticular disease

Most people with diverticulosis will never experience any problems. Only about 15-25% of patients will develop diverticulitis and about 5-10% will develop diverticular bleeding. Most patients with diverticulitis respond to medical therapy and only about 15% of patients will need surgery.