Diverticular Disease

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  • Shares symptoms with irritable bowel syndrome & chronic constipation
    • Intermittent attacks of abdominal pain
    • Erratic bowel habit
    • Abdominal bloating and passage of excessive flatus
  • Chronic lack of fibre
  • At least third of population over 60
  • Females > Males
  • Pockets of mucosa herniate through weakness in bowel wall - where mucosal blood vessels penetrate

Complications

  • Spreading pericolic inflammation
  • pericolic abscess
  • intraperitoneal perforation
  • acute rectal haemorrhage
  • fistula formation into other abdominal or pelvic viscera
  • bowel to bowel adhesions
  • fibrous strictures of bowel

Presentations

  • Chronic grumbling diverticular pain
    • chronic pain
    • erratic bowel habit
    • chronic constipation
    • ? mild left iliac fossa tenderness
  • Acute diverticulitis
  • Pericolic abscess
    • persistent pain and tenderness
    • swinging pyrexia
    • incomplete obstruction
    • sometimes sepsis or PUO
    • (may be presentation of perforated carcinoma)
    • Antibiotic treatment or operation
  • Diverticular perforation
  • Acute rectal haemorrhage
  • Fistula formation
  • Intestinal obstruction
 

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