Diverticulosis And Diverticulitis

Diverticula are pouch-like protrusions out of the intestinal wall and their multiple occurrence is called diverticulosis. Diverticulosis is typical for the large intestine, especially for its left part. It is not a disease but can lead to some pathological complications. Diverticulosis is common in developed countries such as the USA and European countries (in Africa, diverticulosis is extremely rare). Diverticula are often found in patient over 50 years of age, but they rarely affect even younger people.


The problem is the civilized way of life and improper diet. People living in developed countries usually have an insufficient intake of dietary fiber. It is important to eat at least 30 grams of fiber a day but many people do not eat even one third of this amount. The fiber is indigestible and it is excreted in faces. Despite that, it is very important as it increases the stool volume and prevents constipation. Africans receiving a lot of fiber have a bulky and runny stool. People with insufficient dietary intake have more solid stool of a lesser volume. And now imagine that such solid stool must be transported by the intestines. The intestinal muscles must work harder to allow passage of the stool and this leads to increase of local pressure within the intestine. The pressure can cause formation of pouches protruding from the intestinal wall – the so-called diverticula.


When the intestinal bacteria multiply in the diverticulum or when it is closed by a piece of stool, a local inflammation may occur. This condition is called diverticulitis.




Scheme of diverticulas in the end part of the colon



Diverticulosis itself does not have usually any serious symptoms. A person with diverticulosis may complain about frequent constipation and flatulence but this is not the rule. Diverticula can also bleed and in this case we find bright red blood in the stool.


Diverticulitis can be a serious condition. It causes abdominal pain that is usually located in left lower abdominal quadrant. The inflammation may be further complicated by development of intestinal fistula or abscess. Healing process of an extensive diverticulitis can cause strictures of the intestine that increases risk of the intestinal obstruction. The most serious complication is a rupture of the pouch and intestinal perforation followed by leakage of intestinal contents into the abdominal cavity causing peritonitis.


Diverticula can be diagnose by imaging methods such as barium enema when the contrast medium fills the intestine a wee see the pouch-like protrusions. Larger diverticula can be visualized even by simple computed tomography of the abdomen. However, the best diagnostic method is the colonoscopy. Diverticula look like small holes in the intestinal wall and the examining physician must be very cautious not to perforate larger diverticula with the endoscopic device.


Risk of a diverticulosis occurrence can be minimized by healthy diet with adequate fiber and fluids intake and regular physical exercise. As mentioned above, we should eat at least 30 grams of fiber per day. Any upper limit of fiber intake does not exist, but its excessive intake can cause diarrhea.


Once emerged diverticulum is incurable by conservative means. Diverticulitis is treated with antibiotics. Symptomatic diverticulosis causing diverticulitis or diverticulitis that does not respond to the antibiotic therapy may be treated surgically by removing the affected part of the intestine. Especially when operating in acute infectious condition, a temporary colostomy may be necessary.

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources