Diverticular colitis - therapeutic and aetiological considerations

OBJECTIVE: Treatment of diverticulitis may change when associated with mucosal inflammation of either ulcerative-like or Crohns-like colitis. To determine effective treatment of diverticular colitis, four cases were analysed. Mechanisms to account for the colitis associated with diverticulitis are put forward. PATIENTS AND TREATMENT: Four cases had colitis and active diverticulitis established by clinical, colonoscopic or CT evidence of active inflammation. Biopsies confirmed mucosal inflammation: two with ulcerative colitis-like and two with granulomata suggestive of Crohns-like colitis. Treatment for colitis in all cases included sulphasalazine and steroids in two cases. RESULTS: Colitis subsided in three cases but one had continuing inflammatory polyps and one case did not resolve. Segmental resection was performed in two cases one with continuing colitis and one with inflammatory polyps. No further attacks of colitis have occurred since the initial observations were made or operations performed. CONCLUSION: An association of colitis with diverticulitis has been confirmed by present observations and case reports of others. Colitis requires medical treatment and if inflammation fails to resolve, segmental resection is indicated. Diverticular colitis, either ulcerative colitis-like or Crohns-like, is part of the spectrum of acute diverticulitis.