Sunday, January 8, 2012

Colonic Diverticular Disease

Colonic diverticulosis is among the most common diseases in developed Western countries. In the United States, diverticulosis occurs in approximately one third of the population older than age 45 and in up to two thirds of the population older than 85 years,1,2 and it also affects a significant proportion of younger adults.

Definition and causes

A diverticulum is a saclike protrusion in the colonic wall that develops as a result of herniation of the mucosa and submucosa through points of weakness in the muscular wall of the colon. The colonic diverticulum is a false or pulsion diverticulum-that is, it does not contain all layers of the colonic wall. Diverticulosis indicates the presence of multiple diverticula and generally implies an absence of symptoms (Fig. 1). Diverticular disease implies any clinical state caused by diverticula, including hemorrhage, inflammation, or their complications. Diverticulitis describes the presence of an inflammatory process associated with diverticula. Its pathogenesis is attributed to genetic and environmental factors (Box 1).
Genetic factors
Environmental factors
  • Low-fiber diet
  • Obesity
  • Decreased physical activity
  • Corticosteroids
  • NSAIDs
  • Alcohol
  • Caffeine intake
  • Cigarette smoking
  • Polycystic kidney disease
Epidemiologic factors
  • Age
  • Geography
  • Life style
  •  Ethnicity


Medical Treatment

Complicated diverticulitis refers to acute diverticulitis accompanied by abscess, fistula, obstruction, or free