Diverticular Disease

Conditions: Large Bowel
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What is Diverticulosis?

Diverticulosis refers to a condition in which there is outpouching of the large bowel, typically affecting the lower portion, called the “sigmoid colon”, associated with weakness of the bowel wall. There are a number of risk factors associated in developing this condition, these include advancing age, a diet poor in fibre and constipation. Patients who have this condition are typically asymptomatic and no medical management is needed, however a high fibre diet is advised.

Contrast radiography of the large bowel showing common changes seen in Diverticulosis
Diverticulosis as it appears on an X-ray of the colon

What is Diverticular Disease?

Patients with diverticulosis can have complications as a result of acute inflammation and this is called, Diverticulitis. Symptoms that patients will commonly experience include, lower left sided abdominal pain, PR bleeding (typically fresh blood) which is painless, and if the underlying precipitating factor is infection, then fever and sweating are common.

Diverticulitis affecting the large bowel
Patients with Diverticulosis can have complications as a result of acute inflammation and this is called, Diverticulitis

In certain cases this can be the first presentation of the condition, and due to the risks associated with diverticulitis which include significant blood loss, sepsis and bowel perforation, patients are admitted to hospital for investigation, observation and treatment.

CT imaging modality to identify pathologies affecting different abdominal organs
CT imaging of the abdomen and pelvis to confirm diagnosis of diverticulitis

Patients are initially given a course of intravenous antibiotics, and undergo CT imaging of the abdomen and pelvis to confirm diagnosis and to assess if there is evidence of associated complications. However in cases where the patient presents with an acute abdomen as a result of bowel perforation the patient may need to undergo emergency surgery due to the risk of sepsis, as this is potentially fatal.

Surgery in an emergency setting will be an open procedure (Laparotomy), if there is evidence of bowel perforation a segment of the bowel is removed, and a temporary stoma is made (Hartmann’s procedure) to allow the bowel to heal and inflammation to subside which is then reversed later. In some cases part of the bowel can be resected and the two ends joined back together during the same operation (Left colectomy). Recovery will depend on a number of factors including the type of operation performed and underlying co-morbidities.

However in most cases patients presenting with diverticulitis will only need conservative management of intravenous antibiotics and fluids and are typically discharged within 3-5 days of admission if there are no complications. Once the inflammation has settled the patient will undergo either a flexible sigmoidoscopy or colonoscopy, which is usually 6 weeks after presentation to hospital.

What are flexible sigmoidoscopy and colonoscopy?

Colonoscopy performed to visualise the anatomy of the large colon
Patients presenting with diverticulitis will undergo either a flexible sigmoidoscopy or colonoscopy

Both flexible sigmoidoscopy and colonoscopy are diagnostic endoscopic procedures done while the patient is conscious, rarely sedation is needed. It involves a fibre-optic camera being inserted through the back passage to allow visualisation of the sigmoid colon (sigmoidoscopy) or in some cases visualisation of the whole large bowel (colonoscopy). A patient will be given medication referred to as ‘bowel prep’ prior to the procedure, which will help clean the colon to allow optimal visualisation. This is a day case procedure with the patient discharged on the same day. It is advised that someone accompanies the patient due to the effects of the sedatives given if required.