Diverticular disease

Diverticular disease is a benign condition of the large bowel (colon).

The presence of small pockets or diverticular in the large bowel, especially in the “S-bend” of the colon (known as the sigmoid colon), is common in western countries in those over 40 years and increases with age.

One pocket is a diverticulum, many are diverticular, and having many pockets is known as diverticulosis. Most individuals with diverticular are asymptomatic and it is a coincidental finding at colonoscopy.

Diverticulitis is an inflammation in one or more diverticular, and can present with lower abdominal or left lower abdominal pain, change in bowel habits, and fever. Complications of diverticulitis can include abscess formation or perforation. Some may develop a fistula or abnormal connection between the colon and adjacent structures such as the bladder, small bowel or uterus.

Most with diverticulitis are usually treated with antibiotics as an outpatient, with some requiring hospital admission. Those with recurrent episodes of diverticulitis or with complications may require surgery, depending on the situation. Those with an abscess may require drainage, and those with a perforation or fistula may require surgery if fit enough.

Most patients proceeding with elective surgery for recurrent diverticulitis require resection of the sigmoid colon and usually avoid a stoma or bag. Many patients requiring emergency surgery for diverticulits and its complication require the formation of a bag, with a segment of bowel brought out through the abdominal to the skin, but it is often temporary, as long as they are fit for further surgery.

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