WHO GETS DIVERTICULAR DISEASE AND DIVERTICULITIS?
• Diverticular disease is common in the ageing population.
• As a broad generalisation, there is a 65% risk of diverticular disease at the age of 65, and a 75% lifetime risk of diverticular disease by the age of 80. In the Caucasian population.
• 80-90% of diverticular disease is within the sigmoid colon compared to the Asian population, where there is a greater predominance of right-sided disease.
• Approximately 10% are pancolonic.
WHAT CAUSES DIVERTICULAR DISEASE?
• The cause is unknown. Many theories exist including chronic constipation and fibre deficiency.
WHAT IS THE RISK OF GETTING DIVERTICULITIS IF I HAVE DIVERTICULAR DISEASE?
• In patients with diverticulosis, the risk of diverticulitis has been cited from around 1% to 25%.
• Diverticulitis may be complicated by perforation, abscess, fistula or obstruction. 10% of patients who are hospitalised with diverticulitis require emergency surgery.
• Complicated diverticulitis refers to macroscopic diverticular perforation which may be localised or may lead to faeculent peritonitis if not contained. A diverticular abscess may rupture leading to purulent peritonitis or it may fistulate into other organs, most commonly the bladder (colovesical fistula).
• Per rectal bleeding associated with diverticular disease is also a complication of diverticular disease, but there is usually no inflammation. Over 30% of lower gastrointestinal bleeding is associated with diverticular disease.
IS DIVERTICULAR DISEASE AND DIVERTICULITIS PREVENTABLE?
• While there is no strong evidence for high-fibre diet, it has been traditionally recommended since 1971. There is no consensus in the guidelines nor studies in the literature.
• Smoking cessation, combating obesity as well as avoiding the use of NSAIDS and corticosteroids may reduce the risk of complicated diverticulitis.
HOW IS THE DIAGNOSIS OF DIVERTICULITIS CONFIRMED?
• By CT scan.
WHO REQUIRES HOSPITALISATION?
• Complicated diverticulitis and diverticular bleeding usually require hospitalization, antibiotics and intravenous fluids with cessation of oral intake. Diverticular bleeds are usually large in volume and require monitoring, supportive management and may require blood transfusions.
• Hospitalization for diverticulitis depends on the severity. Mild uncomplicated diverticulitis may be managed on an outpatient basis with oral antibiotics, with advice to present to the emergency department should symptoms worsen or if there is clinical deterioration.
• Higher grade diverticulitis usually requires hospitalization, and in some cases, emergency surgery.
DO I NEED A COLONOSCOPY?
• Yes, a colonoscopy is required 6 weeks post an attack of diverticulitis to exclude malignancy.
• The risk of a diagnosis of cancer after an emergency presentation with diverticulitis is 1-10%, as the symptoms and CT findings of diverticulitis may mimick colorectal cancer.
AFTER A SINGLE EPISODE, WHAT IS THE RISK OF RECURRENT ATTACKS?
• Approximately 20-30% of patients will get further episodes of diverticulitis. 70-80% of patients will have no further attacks.
• Recurrence usually occurs within 1-2 years after the initial episode.
SHOULD I HAVE ELECTIVE SURGERY?
• Majority of patients with diverticular disease and diverticulitis do not need surgery.
• However, patients with severe diverticular disease and recurrent diverticulitis may benefit from surgery.
• Interval elective surgery after an episode of acute diverticulitis is preferred over emergency surgery because of superior outcomes with lower mortality, morbidity and stoma rates. Stoma rates for emergency surgery have been reported to be over 50%.
• The information above was adapted from our publication. Please refer to our publication on Diverticular Disease and Diverticulitis in Medical Observer for further information:
This material is general information only and should not replace medical advice or instructions given by the health professional. No action or inaction should be taken based solely on the contents provided on this information fact sheet.