Managing diverticular disease

 

Diverticular disease is very common affecting about half of all 60 year old and nearly all 80 year olds. However only a small percentage of people with diverticular disease will have symptoms. As the colon ages it weakens and this can lead to a bulge or pocket forming on the wall of the bowel rather like a bulge in an old tyre. Diverticula can occur throughout the gastrointestinal tract, but are seen most commonly in the sigmoid and descending colon (left side of the colon).

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The condition if often diagnosed while the patient is being investigated for other conditions eg. screening for colon cancer. However, patients can present with non-specific abdominal complaints, e.g. disturbed bowel function, bloating or lower abdominal pain, usually left-sided. Pain is often exacerbated by eating and diminished with defecation or passing wind.

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If the diverticulum becomes inflamed (diverticulitis) then the patient may develop symptoms of varying severity depending upon how inflamed the diverticulum becomes. Generally patients present with left lower quadrant pain and possibly a temperature. One third of patients who develop diverticulitis will develop further complications. The inflamed diverticulum may form an abscess. This gives more severe pain and more severe symptoms of infection (swinging temperature, rigors, racing pulse). Sometimes the diverticulum erodes into a nearby structure creating a fistula. If this is the bladder then the patient may pass flatus and faecal material in their urine. Occasionally the diverticulum can perforate into the abdominal cavity causing peritonitis. This is a surgical emergency.

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Most patients admitted with acute diverticulitis will respond to conservative treatment, but 15-30% will need surgery. Patients experiencing recurrent attacks are less likely to respond to medical treatment and should be offered surgery.

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