Diverticular Disease

INTRODUCTION

Diverticular disease is a problem of the colon (90% in descending colon) and is related to lack of fibre in the diet. It is usually symptomless.

Clinical features

• Typical in middle-aged or elderly >40 yrs

• Diverticulosis—symptomless

• Diverticulitis—infected diverticula and symptomatic constipation or alternating constipation/diarrhoea

  • – intermittent cramping lower abdominal pain in LIF

  • – tenderness in LIF

  • – rectal bleeding may be profuse (± faeces)

  • – may present as acute abdomen or subacute obstruction

  • – usually settles in 2–3 d

Investigations

• WBC and ESR—to determine inflammation

• Sigmoidoscopy

• Barium enema

• US/CT scan (acute disease)

MANAGEMENT

High fibre diet

Symptomatic

• Fibre supplements

• Antispasmodics

Diverticulitis (mild)

Amoxicillin + clavulanate 875 mg (o) bd, 5–10 d

Diverticulitis (complicated)

• Nil orally, IV fluids, analgesics

• Antibiotics

• (Amoxi) ampicillin IV + gentamicin IV + metronidazole IV