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Diverticular Disease of the Colon
1
What is a colonic diverticulum?
A protrusion of mucosa and submucosa through the muscular layers of the bowel wall. It has no muscular covering. Because these diverticula do not involve all layers of the bowel wall, they are really “false” diverticula. Diverticulum formation may be related either to weakness of the bowel wall at the sites of vessel perforation or to increased intraluminal pressure caused by low dietary fiber and constipation.
2
What is the difference between diverticulosis and diverticulitis?
Diverticulosis is colonic diverticula without associated inflammation. Diverticulitis is inflammation and infection. Only 15% of patients with diverticulosis develop diverticulitis.
3
How does a diverticulum cause pain?
Pain comes from inflammation or perforation of the diverticulum. If perforated, leakage may be scant and contained within pericolic fat or extensive, involving the mesentery, other organs, or the peritoneal cavity. Sigmoid diverticulitis typically causes pain in the left lower quadrant.
4
Where in the colon are diverticula usually located?
In the United States, 95% of all diverticula occur in the left colon, primarily in the sigmoid colon. Diverticula, however, may occur anywhere in the colon. In Asia, right colonic diverticula are more common. The diverticula tend to occur on the mesenteric side of the antimesenteric tinea, where small perforating blood vessels create a weakness in the circular muscle of the colon.
5
At what age is diverticulitis most common?
The sixth or seventh decade of life. Younger patients are more likely than older patients to have right colonic diverticulitis.
6
What strategy may decrease diverticulitis in patients with diverticula?
A high-fiber diet. Large bulk in the colon decreases segmentation and intraluminal pressure.
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