Current Diagnosis and Treatment Surgery 14/E

Author:Gerard Doherty [Doherty, Gerard]
Language: eng
Format: epub
Publisher: McGraw-Hill Education
Published: 2015-01-16T08:00:00+00:00

Figure 30–12. Cross-section of the colon depicting the sites where diverticula form. Note that the antimesocolic portion is spared. The longitudinal layer of muscle completely encircles the bowel and is not limited to the taeniae as depicted here.

Epidemiology

In Western countries, 30%-60% of individuals develop diverticula. There is no gender predilection. The prevalence increases with age, although recently there has been an increase in the younger population. Ten percent of patients are affected by age 40 and 65% by age 80. Diverticular disease is more common in Western nations. In Asian countries, there is a predominance of right-sided diverticula. The geologic differences in the incidence of diverticular disease suggest that cultural factors may play an etiologic role. The contribution of a low fiber diet rich in red meat is a commonly cited risk factor but this has not been shown conclusively. Other reported factors include physical inactivity, constipation, increasing age, smoking, obesity, alcohol, and NSAID use. Patients with Ehlers–Danlos and Marfan syndrome, both of which involve abnormal connective tissue, are at increased risk.

Symptoms and Signs

Diverticulosis remains asymptomatic in up to 80% of people and is usually detected incidentally on barium enema x-ray, CT scan, or colonoscopy. A history of constipation is often elicited. An abdominal examination may reveal mild tenderness in the left-lower quadrant, and the left colon is sometimes palpable as a firm tubular structure.

Treatment

Asymptomatic patients with diverticulosis may be given a high-fiber diet, although its role is unclear except as a treatment for constipation. There is no evidence to suggest that avoiding nuts, seeds, or popcorn has a protective effect. In fact, no dietary change has been conclusively shown to treat diverticulosis or prevent its complications, although weight loss, smoking cessation, and a diet low in red meat have been suggested as possibilities. Surgery is not indicated for uncomplicated diverticulosis.

Prognosis

The natural history of diverticulosis has not been defined. Complications of diverticulosis including diverticulitis, hemorrhage, stricture, and fistula formation occur in approximately 20% of patients with diverticulosis. Because these estimates rely on patients with known diverticulosis, the incidence of complications in the general population (who have undiagnosed, asymptomatic diverticulosis) may be much lower. About 75% of patients who present with complications of diverticular disease report no prior colonic symptoms.

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