Diverticulosis refers to the presence of diverticula without inflammation.
Diverticular disease is a clinical term used to describe the presence of symptomatic diverticula
False diverticula (mucosa and muscularis mucosa have herniated through thecolonic wall) between the teniae coli, atvpoints where the main blood vessels penetrate the colonic wall
True diverticula, which comprise all layers of the bowel wall, are rare and are usually congenital in origin
The sigmoid colon is the most common site of diverticulosis
But in South-East Asia, right-sided diverticular disease is more common
Complications
Diverticulitis: Refers to inflammation and infection associated with diverticula. Left sided lower abdominal pain, loose stools, low grade fever, tenderness and sometimes mass palpablee in the left iliac fossa (left sided appendicitis)
Perforation: most often contained leading to pericolic abscess formation
Peritonitis, Intestinal obstruction, Haemorrhage
Fistula formation: Colovesical fistulas are most common
Hinchey classification of complicated diverticulitis
Grade I: Mesenteric or pericolic abscess
Grade II: Pelvic abscess
Grade Purulent peritonitis
Grade IV: Faecal peritonitis
Treatment
High-fibre diet and bulk-forming laxatives
Acute diverticulitis is treated by intravenous antibiotics
Abscess < 5 cm - likely to settle with antibiotics; > 5cm – likely to require intervention.
Urgent or emergent laparotomy
Abscess is inaccessible to percutaneous drainage
Patient’s condition deteriorates or fails to improve
Patient presents with free intra-abdominal air
Peritonitis
Hartmann’s procedure - safest option in emergency surgery
Primary anastomosis – for young and fit patiients without gross contamination or overwhelming sepsis
Elective resection: Recurrent attack, fistuae