Diverticular Disease

Diverticular disease is the general name for a common condition that involves small bulges or sacs called diverticula that form from the wall of the large intestine (colon). Although these sacs can form  throughout the colon, they are most commonly found in the sigmoid colon,  the portion of the large intestine closest to the rectum. 

• Diverticulosis: The presence of diverticula without associated complications or problems. The condition can lead to more serious issues including diverticulitis, perforation (the formation of holes), stricture (a narrowing of the colon that does not easily let stool pass), fistulas (abnormal connection or tunneling between body parts), and bleeding.
• Diverticulitis:  An inflammatory condition of the colon thought to be caused by perforation of one of the sacs. Several secondary complications can result from a diverticulitis attack, and when this occurs, it is called complicated diverticulitis.

Complications of Diverticulitis

• Abscess formation and peritonitis due to perforation of the colon. An abscess is a collection of pus walled off by the body, and peritonitis is inflammation of the peritoneum, often caused by a potentially life-threatening infection that spreads freely within the abdomen, and can cause patients to become quite ill. 

• Rectal bleeding 

• Colonic stricture 

• Fistula formation  When a fistula forms, it most commonly connects the colon to the bladder, but it may also connect the colon to the skin, uterus, vagina, or another part of the bowel.

CAUSES

The most commonly accepted theory for the formation of diverticulosis is related to high pressure within the colon, which causes weak areas of the colon wall to bulge out and form the sacs. A diet low in fiber and high in red meat may also play a role. Currently, it is not well understood how these sacs become inflamed and lead to  diverticulitis. 

SYMPTOMS

Most patients with diverticulosis have no symptoms or complications. However, patients with diverticulitis may experience lower abdominal pain, fever, or rectal bleeding.  

DIAGNOSIS

Diverticulosis often causes no symptoms, and as such, no diagnostic interventions are performed.  It is often diagnosed during routine screening examinations, such as   colonoscopy.  However, patients with diverticulitis are often symptomatic and therefore diverticulitis may be diagnosed during work up of the patient’s symptoms, most commonly with a CT scan of the abdomen and pelvis. 

TREATMENT

Most people with diverticulosis have no symptoms. However, as a preventative measure, people are advised to eat a diet high in fiber, fruits, and vegetables, and to limit red meat. 

Most cases of diverticulitis can be treated with antibiotics in pill form (PO) or intravenously (IV). Diverticulitis with an abscess may require treatment with antibiotics and a drain placed under radiologic guidance. 

Surgery for diverticular disease is indicated for the following: 

• A rupture of the colon that causes pus or stool to leak into the abdominal cavity, resulting in peritonitis. Rupture of the colon often requires emergency surgery. 

• An abscess than cannot be effectively drained. 

• Severe cases that do not respond to maximum medical therapy, which includes hospitalization and intravenous antibiotics. 

• Patients with immune system problems (related to an organ transplant or chemotherapy). 

• A colonic stricture or fistula. 

• A history of multiple attacks, a patient can undergo elective surgery in order to prevent future attacks. 

Surgery for diverticular disease usually involves removal of the affected part of the colon, and may or may not involve a colostomy or ileostomy, where a part of the intestine brought out through the abdominal wall to drain into a bag. A decision regarding the type of operation is made with your surgeon on a case-by-case basis. 

WHAT IS A COLON AND RECTAL SURGEON?

Colon and rectal surgeons are experts in the surgical and non-surgical treatment of diseases of the colon, rectum, and anus. They have completed advanced surgical training in the treatment of these diseases, as well as full general surgical training. Board-certified colon and rectal surgeons complete residencies in general surgery and colon and rectal surgery, and pass intensive examinations conducted by the American Board of Surgery and the American Board of Colon and Rectal Surgery. They are well versed in the treatment of both benign and malignant diseases of the colon, rectum and anus and are able to perform routine screening examinations and surgically treat conditions, if indicated to do so.

DISCLAIMER

The American Society of Colon and Rectal Surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention and management of disorders and diseases of the colon, rectum and anus. These brochures are inclusive but not prescriptive. Their purpose is to provide information on diseases and processes, rather than dictate a specific form of treatment. They are intended for the use of all practitioners, health care workers and patients who desire information about the management of the conditions addressed. It should be recognized that these brochures should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtain the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient.