Pathogenesis, diagnosis, and treatment of diverticular disease of the colon

Diverticular disease of the colon is a disease of twentieth century Western society. A diverticulum is an outpouching of mucosa through the colonic wall. Etiology and pathogenesis are related to altered colonic structure and physiology in an aging population. Epidemiological evidence suggests that a decrease in dietary fiber, as well as increasing age, lead to formation of diverticula. Diverticular disease includes pain without inflammation, diverticulitis, and bleeding. Severe diverticulitis is often complicated by abscess or fistula formation or peritonitis. Young obese men and immunocompromised patients have a more virulent course. Diverticular bleeding occurs as a result of a diverticulum eroding through a nutrient artery. Treatment of diverticular disease depends on severity and clinical presentation. A higher-fiber diet is recommended if there is no acute inflammation. Broad-spectrum antibiotics, diagnostic and therapeutic computed tomography scans, and early surgical intervention have improved the treatment of hospitalized patients with diverticular disease. The one-stage operation has increased in popularity for patients with localized disease because it reduces reoperative rates and hospitalization costs. Mortality remains high in patients with purulent and fecal peritonitis, and early recognition and treatment may benefit this subset of patients.