Diverticulosis and Diverticulitis

A diverticulum is an out pouching of the wall of the gastrointestinal tract that is sac-like in appearance. Diverticula can appear at any level of the gastrointestinal tract including the esophagus, stomach, or the small intestine; however, the most common location is the left side of the colon. Diverticulosis means that unless otherwise specified, diverticula are present within the colon. Diverticulitis is a state of inflammation within a diverticuli. While diverticulosis is rare in a patient under age 30, in Western society the prevalence approaches 50 percent in adults over age 60 and up to 25 percent of these will have complications.

Given the prevalence of diverticulosis in developed societies and the relative infrequency of the disease in nonindustrialized countries, it is thought that environmental and lifestyle factors contribute to the development of diverticula. The wall of the colon is marked by longitudinal bands of muscle that are penetrated by nerves and blood vessels. The sites of penetration of these structures create defects in the muscle wall that are points of weakness for diverticula formation. The herniation of the colonic wall through these defects in the muscle can happen if there is prolonged, exaggerated contraction of the musculature as is seen when there is reduced stool bulk. A diet high in fiber will increase stool bulk and prevent the exaggerated contractions that will cause diverticula formation. The trend in industrialized societies to diets high in carbohydrates, protein, and saturated fats explains the higher prevalence of diverticulosis in these nations. The diagnosis of diverticulosis is often incidental, found during testing for other reasons such as a screening colonoscopy. The majority of people with diverticulosis will remain asymptomatic.

Diverticulitis, or inflammation of diverticula, occurs when there is erosion of the wall of a diverticuli as a result of decreased local blood flow. The decreased flow may be a result of increased colonic wall tension or the impaction of stool within the diverticuli. Diverticulitis can be divided into simple and complicated forms. The overwhelming majority of cases, around 75 percent, are considered simple diverticulitis, which is not associated with complications and will respond to medical management.

Surgical intervention is rarely necessary. Conversely, complicated diverticulitis will often require surgical intervention. As the wall of the intestine is eroded by inflammation, symptoms can develop which include abdominal pain or cramping, nausea and vomiting, diarrhea or constipation, and urinary symptoms. Complications of diverticulitis can include abscess formation within the diverticuli, obstruction of the colon, and perforation of the colon leading to peritonitis and sepsis. In addition, a fistula, or an abnormal connection between two structures, can develop between the bowel and the surrounding anatomy such as the bladder or the vagina.

Treatment of diverticulitis varies depending on the severity of disease. Patients with asymptomatic diverticulosis are often advised to increase fiber intake to prevent development of new diverticula. Patients with simple diverticulitis and mild symptoms can be treated on an outpatient basis with oral antibiotics and a clear liquid diet. If severe symptoms are present, the patient may be admitted to the hospital for intravenous fluids and antibiotics while being kept fasting. If there is obstruction, fistula formation or peritonitis surgery may be necessary to resect the diseased area of the colon or to close the fistula. In conclusion, diverticulosis is a mostly benign condition that can develop complications leading to hospitalization and surgical intervention.

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