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Diverticular Disease
 Diverticular disease or diverticulosis is a common condition of the
colon (large bowel) that affects people as they get older. About 50%
of the population will have diverticular disease by the time they are
60 and nearly everyone is affected at the age of 80. Despite its
prevalence, only a small number of people have any symptoms or have
any idea that they have the condition. A diverticulum is a small
pocket or out-pouching that forms in the colon wall. Although they can
occur anywhere in the colon diverticular disease predominantly affects
the left side and sigmoid colon in particular. The term diverticulitis
is reserved for when these pockets become inflamed and cause symptoms.
What are the symptoms of
Diverticular Disease?
The majority of people have no symptoms, however if a diverticulum
becomes blocked it may become inflamed and lead to abdominal pain,
fevers and an alteration in the bowels. These attacks usually respond
to simple antibiotic treatment occasionally requiring a short
admission to hospital before they settle. More severe symptoms include
perforation of the bowel, formation of an abdominal abscess or severe
bleeding. These conditions may be life threatening and often require
surgery. Some patients develop a fistula following an attack of
diverticulitis. A fistula is an abnormal connection between the colon
and another organ such as the bladder, vagina or even the skin.
Symptoms in these patients include recurrent urine infections, passing
stool from the vagina or recurrent skin infections depending on the
site of the fistula.
What causes Diverticular Disease?
Although the cause of diverticular disease is not fully understood, it
is most common in the western world and probably relates to eating a
low fibre diet. This leads to passing hard stool and increases the
pressure the colon needs to generate to move the stool along. This in
turn results in pockets being pushed out from the bowel wall at points
of weakness such as those where small blood vessels pass through to
reach to inner lining of the gut.
What is the management of
Diverticular Disease?
The best treatment for diverticular disease is to increase the amount
of dietary fibre (grains, vegetables, etc.) eaten and increase the
volume of liquid drunk to avoid constipation. Mild cases of
diverticulitis can be treated with oral antibiotics, more severe cases
often require hospitalisation with intravenous antibiotics but most
attacks respond to these measures. Surgery is required in the
emergency setting for abscesses, bleeding and perforation and involves
removal of the affected part of the bowel.
Often the bowel can be reconnected at
the same operation (primary anastomosis) although if the patient is
very unwell it may be safer to form a stoma and allow the patient to
recover fully (a Hartmann’s procedure). This may be amenable to
reversal at a later stage should the patient wish. Planned (or
elective) surgery is reserved for patients who have developed a
fistula or who are troubled with recurrent severe attacks of
diverticulitis. Most elective operations for diverticular disease can
be carried out using laparoscopic (key-hole techniques) and this
should be discussed with your surgeon. |
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