Diverticular Disease

Published on 31/05/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 31/05/2015

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Chapter 19 Diverticular Disease

INTRODUCTION

Description: Diverticular disease involves herniation of the colon mucosa through the muscular wall. These herniations are most common in the sigmoid and distal colon, increase in prevalence with age, and can lead to significant morbidity when rupture or abscess formation occurs. Diverticulosis is the presence of these herniations, whereas diverticulitis is the symptomatic state.
Prevalence: Twenty percent of patients, increasing with age to 40% to 50% by age 60 to 80.
Predominant Age: Rare younger than age 40, most common in patients older than 50.
Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Speculative, not clearly established. Proposed—defect in colon motility with increased intraluminal pressure, exacerbated by a low-fiber diet or an intrinsic defect in the colon wall.
Risk Factors: Low-fiber diet, age older than 40, and previous diverticulitis.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Asymptomatic (75% to 90%) (diverticulosis)
• Left lower quadrant abdominal pain (worse after eating, better after bowel movement or flatus)
• Diarrhea or constipation
• Fever or chills
• Anorexia, nausea, vomiting
• Abdominal distention
• Peritonitis (rebound tenderness, guarding, rigidity, depressed bowel sounds)
• Rectal tenderness or mass on rectal examination

DIAGNOSTIC APPROACH

Differential Diagnosis

• Irritable bowel syndrome (IBS)
• Lactose intolerance
• Inflammatory bowel disease (ulcerative colitis, Crohn’s disease)
• Carcinoma of the colon
• Infectious colitis
• Appendicitis
• Ectopic pregnancy (in reproductive-age women)
• Tubo-ovarian abscess

Associated Conditions: Irritable bowel syndrome.

Workup and Evaluation

Laboratory: Complete blood count, sedimentation rate, urinalysis with culture.
Imaging: Barium enema generally demonstrates diverticulosis. Supine and upright abdominal radiograph may demonstrate free air in the peritoneal cavity if rupture has occurred.
Special Tests: Colonoscopy or flexible sigmoidoscopy.
Diagnostic Procedures:

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