19th July 2023

Diverticular Disease

Diverticula are small outpouchings of bowel mucosa and submucosa through its outer muscular layer. Risk factors for diverticula formation include increased age, reduced physical activity, raised BMI, low fibre diet and certain medications (NSAIDs and steroids). When symptoms develop that can be attributed to the diverticula, this is termed diverticular disease – this may include intermittent colicky left iliac fossa pain, bloating, constipation and painless fresh red PR bleeding. Acute diverticulitis occurs if the diverticula becomes inflamed – the patient may develop a fever, elevated leu leukocytes and CRP, and tenderness on the PR exam. Diagnosis of acute diverticulitis is made by CT abdomen with contrast. Endoscopy should be avoided during acute inflammation due to the risk of perforation. Diverticula increases the risk of lower GI complications, including abscess or fistula formation, bowel obstruction, GI bleeding, bowel perforation and peritonitis. Disease management depends on the presentation:

Table 2: Management of diverticula-related disease