Colonic diverticular disease

Diverticular disease of the colon is common and the spectrum is broad, ranging from asymptomatic diverticulosis to perforation and massive haemorrhage requiring emergency colectomy.

This article discusses the epidemiology, pathophysiology, symptomatology and management of common presentations of diverticular disease including a brief review of surgical management.

Management is based on the patient's symptoms and signs with assistance from findings at colonoscopy, computerised tomography scanning and occasionally bleeding localisation studies. For minimally symptomatic patients, a high fibre diet is the mainstay of management. Those with diverticulitis require antibiotics and bowel rest, and hospitalisation may be required. Surgery is indicated for recurrent diverticulitis, complicated diverticulitis, perforation and severe bleeding. This involves resection of the affected colon segment and can be performed laparoscopically or open.