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Published on: July 12, 2018
Clinical features of colonic diverticular disease
N Symeonidis1, K Psarras, M Lalountas
12nd Propedeutical Department of Surgery, Medical School, Hippokratio General Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos str, PC, 54642 Thessaloniki, Greece. niksym@hotmail.com
Insights
Colonic diverticular disease affects many, causing symptoms like bleeding or inflammation. Complications and diagnostic challenges highlight ongoing research needs in diverticulitis.
Area of Science:
- Gastroenterology
- Colorectal Surgery
Background:
- Colonic diverticular disease is highly prevalent in developed nations.
- While many with diverticulosis are asymptomatic, one-third experience symptomatic disease, including hemorrhage or inflammation.
- Diverticulitis presents as uncomplicated or complicated, with potential for abscess, perforation, fistula, obstruction, or stricture.
Purpose of the Study:
- To explore the complexities and diagnostic challenges of colonic diverticular disease.
- To address controversies surrounding recurrent diverticulitis and management in specific patient groups.
Main Methods:
- Literature review and clinical data analysis were implicitly used to synthesize information on diverticular disease.
- Comparative analysis of clinical presentations of diverticulitis, irritable bowel syndrome, and segmental colitis associated with diverticulosis.
Main Results:
- Symptomatic uncomplicated diverticular disease can mimic irritable bowel syndrome.
- Acute diverticulitis diagnosis can be challenging, often confused with segmental colitis associated with diverticulosis.
- Significant clinical overlap exists, indicating unresolved questions in the physiopathology of these conditions.
Conclusions:
- The physiopathology of colonic diverticular disease and related conditions requires further investigation.
- Diagnostic clarity is needed, especially given the overlap with other gastrointestinal disorders.
- Management strategies for recurrent or complicated diverticulitis, particularly in special populations, remain areas of debate.
Abstract:
Colonic diverticular disease is extremely common in developed countries. Although the majority of patients with diverticulosis remain asymptomatic, about one-third of the patients manifest the disease with either hemorrhage or inflammation. Diverticulitis may be uncomplicated or complicated by abscess formation, perforation with peritonitis, fistula, intestinal obstruction, or stricture. Controversy exists regarding the aggressiveness of diverticulitis during recurrent attacks of the disease as well as in special groups of patients including immunocompromised patients, young patients, and patients with right-sided disease. Clinical characteristics of symptomatic uncomplicated disease can be similar to irritable bowel syndrome, while acute diverticulitis is sometimes difficult to distinguish from segmental colitis associated with diverticulosis. The considerable clinical overlap between those entities with diverticular disease demonstrates that there are still areas of uncertainty in their physiopathology.
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