Segmental colitis associated with diverticulosis: systematic evaluation of 486 cases with meta-analysis

Segmental colitis associated with colonic diverticulosis is a new and emerging entity. We systematically evaluated 486 cases of this entity and performed qualitative meta-analysis on this information.

This diagnosis was made on a 64-year old man by colonoscopic biopsy. His clinical symptoms included hematochezia and crampy lower abdominal pain. PubMed Search using terms such as segmental colitis, colitis associated with diverticulosis was made without language or time barrier. Additional papers were manually added from the reference lists of key articles. Qualitative meta-analysis was done using the well-established methods of qualitative research, e.g. diagramming, theme repetition without serious contradiction, theme saturation and investigator reflexivity. To facilitate qualitative meta-analysis, summary sheets of publications were created.

This search produced 486 cases with this entity. The prevalence in patients with diverticulosis is 0.3% to 1.3%. There were 58.7% men. The mean age was 63.6 (range 26-87) years. The most common presenting symptoms were rectal bleeding, diarrhea and abdominal pain. Fever, leucocytosis and rectal involvement were characteristically absent. Endoscopic appearance and histology may resemble ulcerative colitis. Many of these patients have a benign course with spontaneous resolution or may respond to 5-aminosalucylates or steroids.

This is a new and emerging entity. There is male predominance and it occurs in relatively elderly patients. It can be distinguished from acute diverticulitis by clinical, endoscopic and histological features. Most have a benign course.