Diverticular disease
Diverticular disease is an outpouching of the colon, usually the sigmoid. It develops from the musculature in the colon working against increased intraluminal pressures to move hard stools through. Other typical sites are the duodenum, near the pancreatic border or the ampulla of Vater, and the jejunum. Diverticular disease of the stomach is rare and commonly a precursor of peptic or neoplastic disease. Diverticular disease of the ileum (Meckel’s diverticulum) is the most common congenital anomaly of the GI tract.
Diverticular disease has two clinical forms. In diverticulosis, diverticula are present but usually the patient is asymptomatic or the symptoms (abdominal pain, fluctuating bowel habits, constipation) are questionable because they may be related to underlying irritable bowel syndrome. In diverticulitis, diverticula are inflamed and may cause potentially fatal obstruction, infection, or hemorrhage.
Causes
Diverticular disease is most prevalent in men older than age 40 and is rarely found in cultures whose diets are high in residue. Diverticula probably result from high intraluminal pressure on areas of weakness in the GI wall, where blood vessels enter. Herniation of mucosa occurs through weak areas of the GI tract.
Diet may also be a contributing factor because lack of roughage reduces fecal residue, narrows the bowel lumen, and leads to higher intra-abdominal pressure during defecation. The fact that diverticulosis is most prevalent in Western industrialized nations, where
processing removes much of the roughage from foods, supports this theory. Diverticulosis is less common in nations where the diet contains more natural bulk and fiber.
processing removes much of the roughage from foods, supports this theory. Diverticulosis is less common in nations where the diet contains more natural bulk and fiber.
In diverticulitis, retained undigested food mixed with bacteria accumulates in the diverticular sac, forming a hard mass (fecalith). This substance cuts off the blood supply to the thin walls of the sac, making them more susceptible to attack by colonic bacteria.
Inflammation follows, possibly leading to perforation, abscess, peritonitis, obstruction, or hemorrhage. Occasionally, the inflamed colon segment may produce a fistula by adhering to the bladder or other organs.
Signs and symptoms
The two forms of diverticular disease produce different signs and symptoms.
Diverticulosis
Although diverticulosis usually produces no symptoms, it may cause recurrent left lower quadrant pain. Such pain, commonly accompanied by alternating constipation and diarrhea, is relieved by defecation or the passage of flatus. Symptoms resemble irritable bowel syndrome and suggest that both disorders may coexist.
In older patients, a rare complication of diverticulosis (without diverticulitis) is hemorrhage from colonic diverticula, usually in the right colon. Such hemorrhage is usually mild to moderate and easily controlled but may occasionally be life-threatening.
Diverticulitis
Mild diverticulitis produces moderate left lower abdominal pain, mild nausea, flatus, irregular bowel habits, low-grade fever, and leukocytosis. Constipation or loose stools and nausea and vomiting are usually present.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
