Diverticular Disease | Types, Causes and Treatment Of Diverticulosis

Diverticular disease

Two types of diverticula’s of colon

1. Multiple false diverticulum’s of left colon, which is known as diverticulosis and
2. Rare true single diverticulum’s of the caecum or ascending colon.

Diverticulosis coli

Causes of Diverticulosis coli

• Diverticula of the colon are acquired herniations of mucosa and sub-mucosa through the circular muscle layer at the points where blood vessels penetrate the colonic wall.
• The mechanism how these diverticula’s are produced is controversial.
• Sigmoid colon is the main site involved. Sigmoid colon plus descending colon are involved in 80% of cases.
• Sigmoid colon plus other colonic sites are involved in 95% of cases.
• Rectum and ascending colon are involved in 4% of cases.
• In about 5% of cases this disease may be associated with gallstones and hiatus hernia (Saint’s triad).
• Diverticulosis itself is an asymptomatic condition.
• Its main two complications are bleeding and inflammation (diverticulitis).

Treatment for Diverticulosis coli

Majority of the patients stop bleeding spontaneously with adequate transfusion and supportive therapy. A safe non-operative method of controlling diverticular bleeding is the selective infusion of vaso-constrictive substances such as vasopressin into the visceral artery supplying the bleeding site after identification by selective angiography.

Diverticulitis

Inflammation is the commonest complication of diverticulosis coli which is called as diverticulitis.

Cause of Diverticulitis

If an inspissated fecal plug obstructs the neck of the diverticulums, proliferation of the ever present bacteria produces inflammation within the diverticulums

The clinical presentation of the diverticulitis very much resembles that of the appendicitis and is often called as ‘left-sided appendicitis’.

Pain is the important symptom along with anorexia and mild nausea.

Diagnosis is done through sigmoidoscopy and barium enema.

Treatment for Diverticulitis

Preventive- condition can be reversed by adaptation of a high residue diet, supplemented by bulk-producing laxatives.

Medical treatment- parentral fluids, naso-gastric suction, broad spectrum antibiotics and drugs to relieve pain are given.

Surgical treatment- disease without complication require sigmoid myotomy. Other cases require resective surgery.